Born in the right body: Introducing 4thWaveNow’s new spokesperson, mom of a teen desister

Brie Jontry is a part-time academic, and a politically liberal mom to an adventurous, wilderness-, insect-, and art-loving teen. She currently lives in the American southwest with her partner and daughter, a huge dog, three cats, and various insects who come and go.

Brie has been a member of the 4thWaveNow community for two years, since her daughter first temporarily identified as transgender. After exploring all kinds of ideas, thoughts, and feelings related to gender identity with her daughter, Brie has decided to speak publicly about her family’s experience.  In particular, Brie agreed to be our public spokesperson to counter the untruth that only religious, anti-LGB conservatives are skeptical about medical transition of gender-atypical young people.

Note: Anyone who has spent time on our site knows we are not a monolith, but a diverse group of parents with varying (though generally congruent) views.  Brie’s experiences and analysis are her own, but are on the whole in line with those of the other gender-skeptical parents in our community.

In a future article, Brie’s daughter, along with a few other teen desisters will discuss their own thoughts about identity, gender nonconformity, desistance, and more. Stay tuned.

As her time permits, Brie is available to interact in the comments section of this interview.


You are the parent of a teenage girl who temporarily believed she was trans, but changed her mind. Can you tell us something about her journey—and yours?

brie resized

Brie Jontry

A few months before my then 11-year-old said she might be transgender, she told me she didn’t want to grow up. She had just met her new pediatric endocrinologist (she has type 1 diabetes) and he told us she was in the early stages of puberty. In the car on the way home from the appointment, crying, my daughter asked me how much longer until she’d start bleeding, until her breasts would grow.

A few weeks after that appointment, Leelah Alcorn, a transgender teen in Ohio, committed suicide by walking onto a highway into the path of a tractor trailer. My daughter was gripped by Leelah’s story, by the horrific choice of death over a seemingly endless painful existence, and she agonized (for weeks) over the details in Leelah’s suicide letter. “What is transgender? Was Leelah a girl trapped in a boy’s body?” “How could her parents not see they were killing her?”

A few months later, my daughter told me she thought she might not be a girl. I asked if that meant she was really a boy and she said she thought so. I said something like, “this is a lot to think about” and asked her permission to speak to her grandfather, a psychologist, and another friend, a genetic biologist and a lesbian. She agreed and sheepishly let me know she’d already told her poppa.

I called my dad that night after she’d gone to bed. He reminded me that she’d always “been her own person” and that imagination and sensitivity could have been heightened by almost obsessively reading/thinking about Leelah Alcorn. He explained body and gender dysphoria, and drew a connection to eating disorders. “You wouldn’t help her starve herself if she thought she was too fat,” he said. “Help her just be her, in her own body, whatever that means.”

Next, I spoke to Audrey, our gay geneticist friend who reminded me of her own teen years and cautioned that she certainly would have considered transition had it been readily available. Together, we looked at the few studies we could find about hormonal suppression in adolescents and testosterone use in healthy female bodies. My friend was horrified by the lack of long-term data available for medical interventions being performed on healthy adolescent bodies. Audrey spoke to my daughter about the hormonal responses which occur in puberty, how besides development of secondary sex characteristics, pubertal hormones are needed for brain development, neural pathways, grey matter. If you “pause” that process, she told us, you’ll be stunting the very growth that will make you into the adult you. “You don’t know who you are yet,” Audrey said, “how can you know that’s not who you want to be?”

My daughter agreed to put medical transition, a process she’d been watching with envy in numerous transmasculine teen videos, on hold while we explored these ideas together.

What followed were two years of emotional upheaval and deep exploration. Family and friends agreed to stop using “girl” and worked hard to remember her requested “kid” in its place.

salt-in-the-soup.pngI pestered anyone who was willing, to talk to me about gender, adolescent development, and hormonal modulation. I talked to someone I knew in the midst of her own gender transition and to her partner. I talked to trans people, gay people, other parents of trans and GNC kids, endocrinologists, a Zohar scholar, educators, radical feminists, postmodern theorists, and child and teen psychologists, including those who designated themselves “gender specialists.” I joined large Facebook groups for parents of trans and gender non-conforming kids (and was subsequently thrown out for posting data about Lupron).

I asked my daughter to show me some of the things she was reading and watching online which led to her realization. Together, we explored all kinds of “you might be trans if…” quizzes and “Am I trans?” posts on Reddit’s “Ask a Transgender” subreddit, various Tumblr blogs, and elsewhere. We talked a lot about stereotypes and gender roles.

At my daughter’s request, we went to the Philadelphia Trans Health Conference, where we met Jazz Jennings and ate pizza with hundreds of transgender kids and their parents. Dinner conversations between parents were clearly divided between stories of natal boys who’d “always been this way,” who “always liked pink” or sparkly princess dresses; who liked to play with dolls and wanted to wear nail polish, and born-girls who, on the cusp of puberty, often friendless, suddenly came out as “trans.” My daughter made a lot of new friends that night, some of whom now, two years later, have been on testosterone for a number of years; some have had mastectomies. Of the teens she met that evening, I’m aware of one other who has also desisted.brie pull 2Ultimately, what brought her to the realization that she is not “in the wrong body” (about two years later), were endless, ongoing conversations about sex-based norms, gender roles and expectations, misogyny, and homophobia, between her and lots of other people, mostly women. NO ONE fits neatly into any stereotype associated with their “identity.” She came to understand that her suffering wasn’t because her body was wrong; she was suffering because growing up is hard! To her, “being trans” explained a lot of her discomfort and anxiety, but she came to realize that it wasn’t actually “being trans” that caused any of it.

She came to see medical transition as physician-assisted self-harm. In a twisted way, it helped that she is already dependent on synthetic hormones for her life. She has zero choice about injecting insulin every time she eats, or when her blood glucose is too high, up to ten times a day, for the rest of her life. When her friends who’d started HRT complained about needing injections, something snapped in her. She saw the stark difference between needing pharmaceutical treatment to live (no choice) and desiring it as treatment for a feeling. Her body IS, actually, wrong. It’s verifiably broken and without synthetic hormonal supplementation numerous times a day, every day, she will die. Quickly and painfully.

She realized that her friends had healthy bodies but that their therapists, their friends online and in real life, and sometimes even their parents, were supporting them in the belief it was their bodies that were wrong because they didn’t match their personalities, their preferences, who they were supposed to love. When she realized this, she got angry. She felt tricked into believing there was something wrong with her because she didn’t want to be ogled by teen boys, or wear dresses, or because one of her favorite things was to talk about the difference between aquatic and terrestrial isopods.

So it sounds like she experienced a “rapid onset” gender dysphoria in adolescence, a phenomenon which is now only starting to be recognized.

Yes. And…no. She told me that prior to Alcorn’s suicide, that she wasn’t aware that being transgender was possible, that it even existed. Once she came into contact with the idea, it captivated her and she quickly identified her “transness” as the reason she didn’t want to go through female puberty. She wasn’t alone. Numerous girls in her various peer groups would come out as trans in the coming year.

I think it is critical to this discussion, though, to talk about all the ways she’d been “gender non-conforming” up to identifying as trans.

As liberal, progressive, feminist parents, we never put energy into making sure our daughter adhered to gender norms. As a baby, she wore all the colors and never had a head-squeezing headband to denote “girl.” I never bothered correcting strangers who thought she was a boy. I insisted she wear a dress once, to a wedding, when she was eight. She cried.

When people asked her if she was a boy or a girl, she’d bark, or meow, or roar.

brie pull 4When she was younger, her favorite toys were stuffed animals, scraps of fabric, cardboard boxes, and small plastic insect, dinosaur, and dragon figures. Then, as she got older LEGO, but never the pink sets. She played lots of imaginative games with her stuffed animals and little figurines and dump trucks; she never wanted a doll and cried once when she was four and someone gifted her one. She couldn’t understand how someone who knew her might think a Mermaid Barbie would be a welcomed present.

Her favorite stuffed animal was a crab named “Crabby” who went almost everywhere with her. When people asked if Crabby was a boy or a girl, she’d answer: “she’s a boy” or “he’s a girl” and laugh. Outside, she liked to pee standing up, like her dad, and somehow figured out how to pee farther than her best friend, a boy.

She mostly preferred “boy’s” clothing: sweatpants and shirts with insects, dragons, monsters, and dinosaurs. We let her choose her own clothing as soon as she wanted to and had no problem with her heading over to the boy’s section of stores.

These are important details because once I turned to trans-affirming websites and books (which were all I could find until I learned the phrase “gender critical”), the gender nonconforming choices she made, her preferences, some of her behaviors, could easily be read as proof that she really was a boy, that she had a “boy brain,” and perhaps, that she was exposed to too much testosterone in utero as evidenced by her relative finger length.

The acute stress she felt over her body (dysphoria) was indeed rapid-onset. However, looking back, there were many incidents which could have been interpreted as signs of an “innate gender identity” that didn’t match her sex.

Trans activists have tried to convince the public that “desistance is a myth”. Yet your daughter did indeed desist. Why do you think activists want to deny the experiences of young people like your daughter?

Because desistance justifies cautious, rational, skepticism. Desistance proves that some people think of themselves as transgender and then come to think of themselves as not trans. Desistance creates doubt.

When I say “desisters,” I’m talking about those who once thought of themselves as trans but do not currently see themselves that way. Desisters like my daughter and the other young people we know, never took steps to medically transition although they considered themselves transgender and in most cases, looked forward to medical intervention of some kind.

Desistance stories are often criticized as being about kids who were never “really trans” to begin with. Brynn Tannehill, a board member of the Trans United Fund, argues that the 84% desistance rate is inflated because it caught up a lot of gender nonconforming kids in place of “true trans” kids–so of course they desisted; they were never trans!

Here’s the thing, neither was my kid. Chances are, most of the kids of parents reading here aren’t trans.

Let’s assume for the moment that there is such a thing as “true trans.” What does that mean? Let’s say there is at least minimal proof that gender identity is innate and biological (there isn’t). Let’s pretend that we have long-term data showing that medical intervention in adolescent development is beneficial to those who don’t fit easily into gendered expectations and norms and to those who suffer from dysphoria.

Now, let’s say that all the previous gender-atypical behavior my daughter exhibited growing up was resultant from a biological abnormality.

So what?

So what if she sits on the far end of the bell-curve’s tail of female behaviors and preferences? How does that make her “other?” Why does that mean she’s in need of medical intervention to “correct” something deeply amiss?

Why can’t she and all other outliers be supported as they are without needing to be fixed? Have we learned nothing from the historical horror show of medical interventions enacted on children with differences in sexual development (“intersex”)? Why does being an outlier mean that she’s “really a boy?” instead of simply, that she’s different than the female norm?

Desistance as a likely possibility gives rise to the “wait-and-see” approach, which according to some “affirmative” gender professionals, is just as dangerous to kids as insisting they’re not trans. This horrifies me, that cautious “wait and see” approaches are discouraged when there is zero evidence that socially and medically transitioning children and teens is beneficial, apart from (parent reported) immediate gratification and short-term validation.

The affirmation model used widely in the US is actually highly controversial. In the UK, a doctor is under investigation for providing cross-sex hormones to children as young as 12—a situation being normalized at pediatric gender clinics in the US.  Under-18 surgeries take place in the US, while they are prohibited in the UK—and even Thailand, once known as a go-to place for underage procedures.  US “affirmative” clinicians behave as if the debate on child transition is over, even though leading researchers at 17 worldwide locations cautioned in a 2015 journal article that “in actual practice, no consensus exists whether to use these early medical interventions.”

brie pull 3And still, WPATH argues in favor of lowering age limits for medical and hormonal treatment and easing access to transgender medicine. In the US, some pediatric gender practitioners and their advocates act as if this course of treatment is settled science. It isn’t. Even the gender specialists in the Netherlands who pioneered the use of puberty blockers in “trans kids”  caution against socially transitioning younger children, because kids who don’t socially transition seem to mostly work it all out by themselves, and some socially transitioned youth who changed their minds found it very difficult to desist later.

Desistance stories also add weight to recommendations for cautious approaches that focus on first treating underlying mental health issues. That’s problematic in a climate where trans activists want to completely depathologize transgenderism. I know a lot of families whose children currently think they’re trans. In almost every instance, there are prior mental health diagnoses or family experiences of trauma.

Parents like you—many of whom are contributors on 4thWaveNow—are castigated as “transphobes” or (at best) “unsupportive.” What do you say to these charges?

Supporting children in desiring and procuring plastic surgery, synthetic hormonal suppression and supplementation is not healthy, supportive, enlightened, or progressive.

Authentic selves do not require surgical and hormonal treatment unless there is underlying pathology, like for my daughter’s autoimmune condition which requires daily hormonal supplementation.  Medical transition should be a last resort for those whose suffering cannot be ameliorated otherwise.

Becoming a life-long medical patient is not liberating; it is enslaving. Being critical and cautious is not hatred, it’s being a good parent.

Gender dysphoria is real and it causes real suffering. My daughter was in deep, profound, pain.

After initial hesitation, I knew my child was not “born into the wrong body” and that as her parent, I would be doing more long-term good (and also less long-term harm) by offering her the time and tools she needed to see herself as whole, capable, and “authentic” as she was instead of affirming that there was something wrong with her.

I think that the most supportive thing we can offer our children is to take apart all our preconceived ideas about gender and identity alongside them. I was told by parents of trans kids and gender therapists that the only expert on my child’s gender identity was my child and that asking “why?” “what does that mean?” “How did you arrive at that conclusion?” “Who are your sources?” and a thousand other questions which would lead down a thousand other rabbit holes, was transphobic, unsupportive, and harmful to her well being.

They weren’t. Those are exactly the questions that helped her make sense of herself, helped her feel whole instead of in need of corrective treatment, helped her be resilient in the face of disappointment and learn to manage both real and perceived limitations.

The stories we’ve been telling aren’t enough. They don’t go far enough. Deep enough. They’re too easy. The answer isn’t a pill or plastic surgery. How many children were prescribed Ritalin simply because their bodies couldn’t stay still? I mean, come on. An entire industry has risen up around trans kids. Careers are being made, not just in the medical field but in education, policy, fashion, the media, all because normal, developmentally appropriate childhood behaviors have been repackaged as (often homophobic) pathologies. We’ve seen this before.

Being “trans” is too easy. It’s an identity picked off a shelf and inside the packaging, there’s a list of other necessary components one must procure before reaching authentic selfhood. “Being trans” to girls like my daughter is like a quest in a video game with each “affirming’ “medical procedure acquired is an “epic win” bringing you one step closer to having all your problems solved. Except no video game exists that suppresses development or leads to the removal of healthy body parts. Being trans isn’t a video game, it’s real life. Real, painful, confusing, life and being trans was the defining aspect not only of identity but also the root of all her suffering.

I supported my child in her journey. What I didn’t do was accept the first and easiest answer. I helped my daughter know that disagreement or unacceptance of any gendered norm was more than okay. I fully supported what my generation quaintly called ‘gender bending” in all ways, but I didn’t agree to let her subject herself to significant bodily harm in an attempt to treat her dysphoria. From the very first announcement, I let her know that she could cut her hair however she wanted, wear whatever clothing she wanted, and use whatever name she chose.

I supported her in her discomfort, to the best of my ability, and I also let her know that discomfort and confusion are legitimate aspects of a meaningful, deeply explored life.

 There are two rationales given for the urgent need to medically transition young people: the risk of suicide, and “passing” better as the opposite sex if puberty is blocked. Do you think these reasons are valid, and if not, why?

Major life moves made from a place of fear and lack of choice are rarely successful. Kids don’t kill themselves because they’re trans. Suicidality needs to be treated as a dysfunctional response to unhappiness, not as a symptom of being trans. Anxiety needs to be treated as anxiety and not as a symptom of being trans. Depression needs to be treated as depression and not as a symptom of being trans. And suicide should not be used as a strategy to manipulate vulnerable parents desperate for “expert” advice or to prime kids to take their own lives. Stop already. That stuff’s contagious.

Most of the parents who’ve agreed to support medical transition for their children and the various gender “experts” I’ve talked to over the past few years argue that children who transition young will pass easier. That’s a problem, because prioritizing “passing,” like much of the surrounding ideology, actually reinforces binary perceptions of gender by suggesting there is only one way to be/to look like a man or a woman. I know gorgeous women with broad shoulders. I know handsome men who can’t grow a beard. So what? The effects of testosterone on a natal female are rapid, and some, like the growth of facial hair, male pattern balding, and changes to one’s voice are irreversible. Besides, it’s recommended that natal females taking testosterone for more than a few years have a full hysterectomy to minimize increased risks of some cancers. Therefore, early transition does not limit later medicalization. Sometimes, it even increases the need for more intensive and painful procedures later.  I think it would be far healthier for those who are gender-atypical and for society to get rid of the idea of “passing” completely.

Until recently, the only critics of pediatric transition seemed to be people primarily from the conservative right.  They tend to conflate transgenderism with gay rights, and are opposed to both. What is your own political affiliation and viewpoint?

Oh, I’m left-of-left. Another reason I want to speak out is because most opposition to trans advocacy comes from the conservative right and IS deeply entrenched in sexist and homophobic beliefs.

Most on the left are too afraid to speak out for fear they’ll be labeled as transphobes, bigots, TERFs, bio essentialists, and just plain old shitty, hateful, shallow-minded people.

Sigh.

Look, if an adult decides after careful and hopefully well researched, in-depth exploration into why they want to undertake surgery and/or HRT, and they fully understand–to the extent it is possible to understand given the lack of long-term data—what their medical choices could mean 5, 10, 40 years down the line, I believe they should be free to make whatever medical choices they and their support team believe to be best. I think insurance policies or better yet, a national health insurance policy (I can dream), should pay for all services related to transgender care.

I believe trans people should be protected against discrimination in education, healthcare, employment, and housing. I want trans people to feel safe walking down the street. I want them to be safe walking down the street.

What do you hope to achieve as public spokesperson for parents of trans-identified young people?

I want to make the conversation larger; I want it to go deeper; I want the medical community to keep their ‘corrective treatments’ away from our children’s bodies. It’s not okay to offer them life-long patienthood without first giving them tools and support to explore the “why?” the “what next?” and a myriad of other possibilities and conclusions.

Currently, the only voices in the discussion are those involved with the industry that’s risen up surrounding transgender medicine. I want to take the discussion beyond the self-declared “experts” who are making entire careers off of the notion that it’s possible to be born into the wrong body.

Many advocates of medical transition for youth claim that there are “true trans” kids who are very different from merely “gender nonconforming” youth. Do you agree?

No. I think almost every human on earth is gender non-conforming in some ways. I was listening to Georgia Warnke recently. She’s largely responsible for getting the medical community to stop performing surgeries on young intersex children, and she helped people learn to be more comfortable with ambiguity in sex and gender presentation. She cautions that we don’t want identities to “go imperial,” a phrase she borrows from Kwame Anthony Appiah who writes that some identities “risk becoming the obsessive focus, the be-all and end-all, of the lives of those who identify with them,” and they “lead people to forget that their individual identities are complex and multifarious.” I’m concerned that’s what’s happening with many of our youth.

Their lives are boring, they’re isolated, the earth is dying, the economy is dying, their families are disintegrating, they’re carrying so much. I can’t imagine a more difficult age to come into ‘ideological’ adulthood than this one. I think a great many young people identifying as trans are doing so because it’s the only life-shaking, meaning-bringing area of their lives they have any control over. Being trans is an answer, a solution, and a meaningful marginal identity during a time in history when being a member of an “oppressed class” also begets greater social currency in some circles.

We’ve given them surfaces. Reflections of reflections of copies. The Mirror Stage mirrored and misidentified. A rose wet with Photoshop dew on a handheld screen that’s the first thing they touch when they wake up and the last thing they touch before they go to sleep. We parents didn’t realize what was happening. We couldn’t predict how digital lives would bleed into reality, that we’d need to clarify what we mean when we say the word “cloud.” Another mom going through this says, “online worlds seep into life like too much salt in a soup.” Curated personas, best friends you’ve never smelled or touched, avatars brought to life.  The Junior Oxford Dictionary removed the words “acorn, ash, buttercup, dandelion, fern, ivy, nectar, pasture and willow” to make room for: “blog, broadband, celebrity, chat-room, mp3 player and voicemail.”

Huge, meaningful and exciting swaths of our kids’ lives have played out in digital worlds while their material worlds have become smaller, more isolated, and disconnected. In many cases, our kids were already disassociated from their bodies, even before they became aware of trans identities. Running, jumping, dancing, wrestling, all these things happen primarily in controlled spaces now. The only remaining place for many young people to gather away from adult-controlled, contrived, and protected spaces, are digital worlds. It follows, in this climate, that “authentic selves” might also be technologically-mediated products to consume. My god, talk about planned obsolescence. This is planned obsolescence of the body from the moment of its birth and our kids are early test subjects in transhumanism. For real. No tinfoil hat needed. Google “postgender.”

No. I don’t believe that there’s such a thing as “true trans.” I believe we’re all mosaics of hormonal, skeletal, emotional, personal, etc. traits and that identity is being commodified in dangerous ways.

Your daughter is only 14. The “affirmative” clinicians will say, see? She just wasn’t really trans. No one can be “made” to be trans, so your daughter just figured out she wasn’t. No harm done.

The only reason my daughter figured out she isn’t trans is because I gave her space, time, and access to diverse people to talk to. I did not, as was advised, immediately affirm her new trans identity. Had I done so, had I said, “oh, yeah, that makes sense” she would most likely, she says, be taking testosterone now. She thanks me regularly for not believing she was a boy trapped in a girl’s body.

Related to the previous question, how do you know your daughter won’t change her mind again and realize she actually is trans? Again, the activists/affirmative clinicians will say maybe she’s just staying “in the closet” about being trans to please you.

I don’t know that my daughter won’t change her mind. How could I? What I know is that she spent the past two years interrogating her dysphoria: where it came from, what purpose it served/didn’t serve in her life; what triggered/increased/decreased its intensity. For the most part, she faced her dysphoria, anxiety, and past trauma head-on and learned ways to live in her body more comfortably.

Is she just waiting until she leaves home to come out again? Best to ask her [Note to readers: We will!] but I don’t think so. She’s angry that she wasted two years of her childhood worrying about her gender identity. She sees her non-conformity with gender roles and her non-compliance with “femininity” as aspects of her individual personality, not as pathology in need of corrective medical care. To her, and she can explain this better than I can, being “trans” means accepting that males/females can only be one way, that some aspects of identity/personality/self-essence beyond biological functions belong to only males or females. She doesn’t believe that’s true.

Do you oppose medical transition for all youth? Why or why not?

No. I believe that for some youth, pharmaceutical treatment might bring the most relief. I do not believe that surgery to remove healthy body parts should ever happen on children or adolescents.

Physically altering (and sterilizing) bodies as a “corrective measure” is nothing new. The history of medicine overflows with horrors enacted on dark skinned and disabled bodies, the bodies of women, and of homosexuals. Doctors in the Netherlands, where homosexual males used to be surgically castrated, were the first to suppress natal puberty in trans identifying children. I think that history, of medically-supported and induced harm on noncompliant bodies, is important to keep in mind when thinking about transgender medical treatment. I mentioned Ritalin earlier. But let’s remember lobotomies, cures for hysterical women, female genital mutilation. Let’s remember that puberty suppressants followed by cross-sex hormones will sterilize a body for life. Gender specialists are sterilizing and greatly increasing the risks of cancer and other debilitating medical conditions in children, many of whom would simply have grown up to be gay in earlier times.

Caution. We have to be more cautious, not open the gates wider. Puberty suppressants, cross-sex hormones, and surgery, all have life-long consequences. Shouldn’t the focus be on helping people learn to accept themselves, in all their messy, unmatched, contradicting, and possibly limiting, glory? We contain multitudes, right? Let’s contain them in the healthiest of possible bodies, with the least amount of dependency on chemical and specialized medicine.

We all want to thank you for stepping forward as public spokesperson for 4thWaveNow. As you are well aware, many parents feel they cannot go public because of the current political climate.

I want those of us who live with and care for young people investigating their gender identities to think more critically and carefully about the idea that humans can be born into “wrong bodies,” and that “authentic selves” are dependent on medical consumption. I want to push the conversation beyond “because I am trans” answers. That’s not good enough. There’s more here and we owe it to our kids and future societies to ask harder questions and to wait, patiently, for more meaningful answers.

I want to speak out because I know others can’t. The risk to one’s livelihood and to the peace of their families and communities is immense. Nothing I am saying is hateful or bigoted but questioning the dominant narratives of innate gender identity and affirmative models of treatment are dangerous moves when even philosophical questions are considered “epistemic violence” against trans people.

This is unacceptable. We cannot think rationally or make well-informed choices if half the conversation is muted. The voices of desisters are important contributions to any discussion focused on dysmorphic adolescents and kids who don’t easily conform to gender norms. I want parents to know that it’s okay to say, “hang on, lets think all this through together.”

You know, if “being trans” simply meant I am who I am who I am and it didn’t often come with a side of medical necessity, I wouldn’t be here insisting we need to talk about this stuff more thoughtfully, more thoroughly.

If sex is socially constructed, like trans advocates argue, why does anyone need to alter their sexed bodies to match their gender identities? It doesn’t make sense. Transgender medicine is being marketed to our young people under the guise that their gender-atypical behavior and/or their developmentally normal bodily discomfort is a sign of incongruity, of imbalance. Normal, healthy teen angst, the challenges of independent identity formation in adolescence, these processes have been pathologized. Instead of helping kids be resilient, many aspects that fall under “gender identity exploration” enable self-perceived and socially-inflicted oppression, hardship, isolation, and malaise.

But, too, in many ways, what’s happening with awareness about gender identities is meaningful and I’m thankful to young people for pushing the rest of us to think about what being “masculine” and “feminine” means in this day and age. Thanks to young people, many are noticing how toys are more gendered now than they were thirty years ago and lots of parents are questioning why boys can’t wear sparkles and why we tell girls to smile. This is all good stuff! But all the good stuff is coming at the cost of our children’s long-term physical and emotional health.

I’m adding our story to the mix because it offers an alternative trajectory to the one that currently dominates the press. In addition to the “courageous trans kid” who lets everyone know that she is a he, I want to highlight young people who’ve come to terms with their sexed bodies and courageously move forward in life without feeling there is something wrong with them, that they’re disabled in some way, that their bodies or other’s perceptions of them are in need of correction.

Both my daughter and I want other parents and young people to know it is possible to work through some/most/all aspects of dysphoria without removing healthy body parts or injecting off-label cancer drugs and cross-sex hormones.

I want parents to know it’s okay to ask questions, to dig deep, to be skeptical. To push your children and those who oversee their care to go beyond “just because” answers like “because that’s how I feel” or, “that’s who I am,” to deeper levels. Push through to “why?” and “what does that mean?” to “where does that feeling come from?” and bravely explore what’s uncovered. What does it mean to “feel” like a woman or a man? Why do those feelings mean healthy bodies are in need of medical intervention? I mean, really, how can it be that so many have suddenly been born “wrong?”

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Layers of meaning: A Jungian analyst questions the identity model for trans-identified youth

Lisa Marchiano, LCSW, is a Jungian analyst. She blogs at theJungSoul.com (Facebook: https://m.facebook.com/thejungsoul), and can also be found on Twitter @LisaMarchiano.

Lisa’s thoughtful essay stands in stark contrast to the simplistic advice we see from self-declared gender therapists like this one. For the perspective of another therapist skeptical of the “gender affirmative” approach, see this post by Lane Anderson, a former therapist for trans-identified teens who quit her job last year due to ethical concerns.

Lisa would like to thank Miranda Yardley, ThirdWayTrans, and Carey Callahan for their contributions to this post. Though these three individuals were generous in sharing their time and expertise, the views expressed here are Lisa’s own.

Lisa is available to respond to your remarks and questions in the comments section of this post. In addition, Lisa is interested in being in contact with other therapists who share her concerns about the identity therapy model:

If there are other therapists reading this and wanting support to question or work outside of the identity model, please be in touch. Contact me privately on Facebook or Twitter, or ask this blog to put you in touch with me via email. There are lots of us out there. Let’s start talking.


by Lisa Marchiano 

As a social worker and a Jungian analyst, I have become increasingly concerned about the rush to affirm children’s and young people’s transgender self-diagnosis, and then transition them to the opposite sex. I am particularly worried about social and medical transition among teens whose transgender diagnosis arose “out of the blue,” without a significant history of early childhood dysphoria. I fear that, via their well-meaning desire to validate young people in pain, therapists are discarding basic principles of psychotherapeutic care.

My views have been informed by my work with detransitioners, as well as with parents of trans-identifying teens. I have also sought to educate myself further by listening to trans people, parents, clinicians, academics, lesbians, feminists, educators, gays, and others who are writing and speaking about gender. I believe that transition may be a viable and even necessary option for some people. I support the right of adults to choose this option with appropriate therapeutic care and support. I certainly believe that trans people deserve human rights, legal protection, humane care, and respect. However, there are potential physical and psychological dangers of transition, and we need to exercise astute clinical judgment and caution when working with young people who are seeking transition.

I have often seen trans activists and gender specialists promote “social transition” of trans-identifying youth as a positive and “fully reversible” intervention. Social transition refers to a number of steps one can take to present as the opposite sex. These might include making changes to one’s hair style, make-up, name, pronouns, and dress. One might also begin binding breasts or wearing a packer to “present” more convincingly as the opposite sex. Social transition is sometimes described as something that has few if any long-term consequences, and therefore can be recommended with minimal concerns,  even for young children. However, in some significant percentage of cases, social transition leads to medical transition. It appears likely that being conditioned to believe you are the opposite sex creates ever greater pressure to continue to present in this way. Once one has made the investment of coming out to friends and family, having teachers refer to you by a new name and pronouns, will it really be so easy to change back? Children who socially transition at a young age may have little experience living as their natal gender. How easy will it be for them to desist?

At least some of the time, each step taken toward transition creates pressure to continue. Numerous blog posts from detransitioners explore how transition made dysphoria worse, often because the young person became increasingly preoccupied with passing. This further discomfort created pressure to take more steps toward transition in order to present more convincingly as the opposite sex. To take just one example, breast binding may bring relief to some natal females who experience discomfort with their breasts, but binding in itself can be quite painful, restricting breathing and movement—thus creating an incentive to take the next step—“top surgery”/double mastectomy. I have heard one mother of a FtM young person stating that this natal female “got his lungs back” after getting a double mastectomy because he no longer needed to bind. Additionally, anecdotal evidence indicates that it is not uncommon for teens who socially transition to move on to hormones and/or surgery shortly after their 18th birthday. So it’s clear that social transition must be viewed as a treatment that carries with it a significant risk of progressing to medical transition.

Medical transition refers to a number of interventions undertaken to alter one’s body. These can include administration of hormone blockers to children and teens; administration of cross sex hormones; mastectomy; phalloplasty; hysterectomy; body masculinization; orchiectomy; vaginoplasty; facial feminization surgery; and others. All of these procedures can have permanent effects, and most of them carry significant risks. It is unusual (though not unheard of) for minors to have these surgeries. However, it is not uncommon for minors to take hormone blockers and cross sex hormones. And in 100% of the cases reported in the literature, children on puberty blockers went on to cross sex hormones. Top gender clinician Johanna Olson reports that no puberty-blocked children at her clinic in LA Children’s Hospital have ever failed to continue hormone treatment. Therefore, the claim that blockers are “100% reversible” is not accurate in practice. In fact, being on blockers appears to consolidate an investment in a cross sex identification. And although one rarely sees this “side effect” reported in the mainstream media, because gametes do not develop when an adolescent does not undergo natal puberty, hormone blockers followed by cross sex hormones results in permanent, life-long sterility 100% of the time.

Hormone blockers and cross sex hormones are being used off label (that is, they are not FDA-approved for this purpose). We have almost no knowledge about the long-term effects of taking these drugs over the course of decades, as anyone beginning transition as a young person will likely do. According to Madeline Deutsch, clinical director at University of California, San Francisco’s Center of Excellence for Transgender Health, “it scientifically makes sense that if someone is on hormones for decades, it’s highly likely that they’re going to be at higher risk [for certain health issues] than someone who started taking hormones at age 40 or 50.” Even the top pediatric gender doctors admit that there’s a dearth of good data on the long-term health outcomes of transition.

Certainly, there are risks. Cross sex hormones change bodies fairly quickly. Some of these changes are irreversible, such as a deepened voice, facial hair, and baldness for testosterone, and breast growth and, potentially, infertility for estrogen. In addition, use of cross-sex hormones carries with it potential negative side effects. Girls who take testosterone will be at increased risk for developing diabetes, cancer of the endometrium, liver damage, breast cancer, heart attack, and stroke. There may be other adverse effects of which we are not aware at this time, since long-term testosterone use in natal females is a relatively new phenomenon that has not been adequately studied.

I fear that there are young people transitioning – with the ready help of therapists, doctors, and others – who may regret these interventions and need to come to terms with permanent and in some cases drastic changes to their bodies. In fact, I know this is already happening. I have had considerable contact with the growing community of detransitioners. In many cases, the hatred for and disconnection from their bodies that these young people experienced was due to sexual trauma, internalized homophobia, or bullying. In videos and blogs, young women speak about their sadness over their lost voices and breasts. Male detransitioners mourn the loss of their testicles, the loss of their ability to orgasm, in some cases the loss of their fertility. Many have had complications from hormones such as vaginal atrophy, nerve damage, or chronic pain. You can hear some of these stories for yourself here, here, and here, among other places.

I have also spoken with many parents. Their stories are just as heartbreaking. These usually involve a teen who was anxious, depressed, socially isolated, or suffering from PTSD coming to identify as trans after internet binges on social media sites. These parents report that mental health professionals are validating the self-diagnosis of transgender after a handful of therapy sessions, without any exploration of prior mental health issues, trauma, sexual orientation, or history of gender nonconforming behavior. This clearly violates APA recommendations, which urge special caution in treating adolescents who present with sudden onset dysphoria.

All of this comes down to an essential question: When treating someone with gender dysphoria, do we do so using a mental health model, or an identity model?

An identity model is founded on the belief that we ought to be able to define our own experiences for ourselves. It proclaims that each of us has a right to assign our own meaning to our lives, our feelings, and our bodies. We get to decide who we are, and no one has authority over our self-perception. An identity model offers respect and self-determination for every person to define themselves as they would like.

An identity model has a place in psychotherapy. As people, we all self-identify aspects of our personality, values, and experiences in ways that are often very important to us. We might identify as Catholic, or as a Democrat. We might identify as an artist, an introvert, or a lesbian. As therapists, accepting and affirming our clients’ self-identification is important and empowering. As therapists, we can accept and empathize with a client’s story about his or her life experience. We can hold this story as valuable and important whether or not we objectively agree with it. As long as the client’s story does not lead to maladaptive behaviors, we do not need to challenge or attempt to discredit or disprove such a self-identification.

However, an identity model of working with transgender people goes further. An identity model stipulates that it is wrong to explore or question a client’s self-determined identity. Gender dysphoria is seen as evidence that someone is transgender, and merely wondering about underlying psychological reasons for dysphoria or alternative explanations for symptoms is seen as synonymous with denying a person’s identity. Applying our own clinical judgment to someone’s proclaimed self-diagnosis is seen as bigoted and wrong. Our role as therapists becomes limited to enthusiastic affirmation only.

In contrast, when we are working in a mental health model, we understand that clients come to us with symptoms that cause distress, and may interfere with a person’s day-to-day functioning. As therapists, we ought to be interested both in helping to alleviate or manage symptoms, as well as helping to understand the underlying cause of the symptom. If we are psychodynamically oriented, a basic assumption of our work is that every symptom has a meaning beyond its superficial presentation, and a major part of our work is to help our clients gain insight about this meaning.

In opposition to an identity model, then, the main task in mental health therapy with a client experiencing gender dysphoria would be to deeply explore the symptoms without making assumptions about what the symptoms mean. In fact, while identity therapy knows what gender dysphoria means – i.e. that the client is trans – mental health therapy will start with the assumption that we have no idea what the symptom means. We must be open to the meaning that emerges for patients as we explore their experience with them.

Seeking to understand deeply the nature, quality, and etiology of the dysphoria is not at all the same thing as denying the reality or importance of the symptom. When I explore a client’s anxiety – when did it start? What tends to trigger it? How does it feel? – I am not implying that I do not feel that the anxiety is unimportant or illusory. As we come to understand more about a client’s unique experience of a symptom, we may unwrap the meaning behind the suffering so that the problem resolves in a surprising, unexpected way. Or we may simply gain better information about the best course of treatment to alleviate the symptom for that particular person.

An identity model is not an appropriate basis on which to prescribe drastic, permanent medical intervention.

An identity model does not leave room for a therapist to exercise his or her clinical judgment. It disallows the possibility of a thorough assessment and differential diagnosis. According to the identity model, a client’s self-diagnosis is not to be questioned or explored. Therefore, alternative causes of dysphoria cannot be sought. As with many other mental health issues, the symptoms of gender dysphoria can be caused by many different things. Feeling uncomfortable with or disconnected from one’s body can go along with being on the autism spectrum; having experienced trauma; having bipolar disorder; having an eating disorder; or experiencing internalized homophobia. And sadly, it is a normal experience for teen girls, 90% of whom express dissatisfaction with their bodies.

An identity model subverts the normal diagnostic paradigm in which a patient presents with symptoms, and the clinician makes a diagnosis. In an identity model, the diagnosis is the identity. This occludes the focus on symptom resolution and management because the priority becomes affirming the identity. When symptoms are seen as validation of an identity, clinical judgment becomes irrelevant.

Before determining that a young person ought to undergo drastic treatments that may permanently alter their bodies and lead to permanent sterilization, a thorough assessment should be conducted that explores all potential factors contributing to the dysphoria. Unfortunately, because exploration of gender dysphoria is construed by some to be tantamount to “conversion therapy,” this kind of extensive assessment is frequently not performed. Though data is sparse, I personally have had contact with dozens of young people and/or their families who received a transgender diagnosis and a prescription for hormones after one to three appointments with a therapist.  According to this survey of more than 200 detransitioned women, 65% of those who transitioned received no therapy at all, either because they were referred for treatment at their first visit, transitioned through an informed consent clinic, or bought hormones through unofficial sources. (The median age for beginning transition in this survey was 17.) Only 6% of respondents felt they had received adequate counseling about transition. In fact, according to the ideology of gender identity, thorough assessment is seen as inappropriate “gatekeeping.”

An identity model does not allow us to rule out cases of transgenderism where social contagion might be at play. It appears quite likely that the striking increase in trans-identifying teens in recent years is due at least in part to social contagion. There has been a sudden sharp rise in the number of children and teens presenting at gender clinics. The first transgender youth clinic opened in Boston in 2007. Since then, 40 other clinics that cater exclusively to children have opened. Inexplicably, the ratio of natal males to natal females has flipped sharply, with many more natal female teens now presenting. Many of these young people have been presenting with dysphoria “out of the blue” as teens or tweens after extensive social media use without ever having expressed any gender variance before. This now-common presentation was virtually unheard of even a handful of years ago. Thousands of home-made videos on sites such as YouTube chronicle the gender transitions of teenagers. These teens show off their new-found muscles or facial hair. The Tumblr blog Fuck Yeah FTMs  features photo after photo of young FtMs celebrating the changes wrought by testosterone. “I finally have freedom!” posters boast under photographs of their scarred chests post mastectomy. “I’m no longer pre-T!” boasts another under a video of someone injecting testosterone. Almost all of these posters are under 25 years of age. According to Jen Jack Gieseking, a New York academic and researcher who was interviewed by BBC Radio 4 last May, “There really isn’t a trans person I’ve met under the age of 30 who hasn’t been on Tumblr.” There are multiple credible online reports of whole friend groups coming out together as trans.

But correlation isn’t causation. As this brilliant blog post explores, the contagion factor only speaks to the particular way that young people choose to deal with distress. It isn’t that the internet is “causing” the rise in transgenderism. It’s that many young people – particularly young females – are feeling alienated from their bodies due to trauma, porn culture, societal standards of beauty, oppressive gender roles, sexism, homophobia, and so forth. Self-diagnosing as transgender becomes an attractive way to deal with the alienation because it is so validated and even lionized in the culture and the mainstream media. For therapists, an identity therapy model does not allow us to acknowledge the role of social contagion, though contagion has been well-documented in contributing to suicide clusters and other behaviors.

An identity therapy model encourages us not to put safeguards in place to prevent young people from undertaking treatments they may later regret. According to an identity model, self-diagnosis as trans should never be questioned. To do so implies a lack of support and even bigotry. Therefore, the clinician must not stand in the way of transition to the person’s “authentic self.” Because of this, an increasing number of minors are going on hormones and even undergoing surgery that will permanently alter their bodies. Even 18 is probably too young to make such major medical decisions. In cases where the 18-year-old is making medical decisions based on a social transition that she or he began years earlier, it is possibly even more likely that that young person has not carefully considered the consequence of transition. Top gender doctors are hoping to see the recommended age for “bottom surgery” lowered.

In sharp contrast, it’s not easy for non-trans patients to be sterilized before adulthood. For instance, in Massachusetts, a patient must be at least 21 years of age to qualify for sterilizing surgeries under the state’s public health scheme. When such a surgery is undertaken, patients are carefully counseled and must sign a form stating that they understand the permanent nature of the procedure, and that they do not wish to bear or father children. Patients must then wait a minimum of 30 days after signing the form before having the surgery. This procedure has been put in place because surgical sterilization has been shown to come with a high incidence of regret. Why are there not similar safeguards in place for those transgender identifying young people wishing to amputate healthy organs and/or sterilize themselves?

There is a wealth of research about cognitive and emotional development in adolescence. The upshot of it is that teens and young adults are more likely to act impulsively, are unable to assess risks well, and are more emotionally reactive. It is partly for these reasons that we do not allow teens to drink, get tattoos, or use tanning beds without adult consent.

An identity model does not allow us to examine the homophobia that drives some – possibly many — transitions. According to extensive research on desistance, a significant majority of children who identify as the opposite sex will not continue to do so into adulthood. The majority of those who desist will come to identify as lesbian or gay. “Feminine” boys are actually many times more likely to grow up to be gay men rather than transgender women. The same is true for “masculine” girls. Many lesbian bloggers (such as this one and and this one) are very concerned that the current trend to transition young people is disproportionately hurting lesbians and gays, and their fears appear to be well founded. This conservative Christian Texas mother was bothered by her son’s “flamboyant, feminine” behavior. Rather than accepting her son’s gender-defiant presentation, she has decided he is transgender. She now has a very pretty, gender conforming “daughter.”

There is widespread concern in the lesbian community that many young would-be lesbian or bisexual women are finding it easier to become “straight men” due to internalized homophobia. In this article, fourteen-year-old Mason describes how he knew he was transgender. “I’ve always known something was up about how I felt about myself,” says Mason, who as Madelyn had refused to wear pink, or to dress in stereotypically feminine attire. “I thought I was gay or bisexual or something.” In years past, Madelyn most likely would have grown up to be a lesbian or bisexual woman. To paraphrase psychiatrist Ray Blanchard, surely it’s preferable to have an outcome of a reasonably well adjusted lesbian woman, rather than someone who identifies as a trans man who has had many irreversible surgeries and a lifetime of drugs.

An identity model makes us unable to tease out other mental health concerns that may be impacting the desire to transition. There is considerable research that points to a high likelihood of co-occurring disorders in young people who wish to transition. For example, this study from 2015 noted that “severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.” In this study, 68% of the population had first had contact with psychiatric service for reasons other than gender dysphoria. Thirteen percent were being treated for psychotic symptoms.

This study from 2004 found high rates of “comorbidity” in those with gender dysphoria, and noted that this was often not taken into consideration when treatment planning for these patients. “Results: Twenty-nine percent of the patients had no current or lifetime Axis I disorder; 39% fulfilled the criteria for current and 71% for current and/or lifetime Axis I diagnosis. Forty-two percent of the patients were diagnosed with one or more personality disorders. Conclusions: Lifetime psychiatric comorbidity in GID patients is high, and this should be taken into account in the assessment and treatment planning of GID patients.”

This 2015 study found a link between gender dysphoria and dissociative symptoms secondary to trauma. According to this blogger, trauma and dissociation were a big part of her desire to transition. This was also true for this blogger here. Similar stories from detransitioners with histories of unaddressed trauma abound.

An identity model does not allow us to take into account reports from parents or previous therapists who may not agree with the patient’s self-diagnosis. I have received dozens of distraught emails from parents trying in vain to get gender therapists to listen to them when they share information about their child’s mental health history that ought to be taken into consideration while assessing and treating gender dysphoria. While I cannot share the contents of these emails without violating people’s privacy, I can point to quite a few places online where frustrated parents have shared similar stories. For example, this social work professor states that the gender therapist did not review her daughter’s special education records or speak with the previous therapist before recommending hormones and surgery for this young autistic teen.

Parents I have had contact with have told me about their child having a history of anxiety, panic attacks, depression, trauma, loss, bipolar disorder, anorexia, cutting, borderline personality disorder, and psychosis. In these cases, as soon as the young person brought up their transgender self-diagnosis, the focus of the therapy shifted to this alone. The parents’ fears, concerns, and information about past treatments were disregarded as obstructionist and transphobic. I am not alleging that this is happening in every case. However, it certainly is happening with some degree of regularity.

An identity model does not allow us to question the incoherence of gender identity ideology. While gender dysphoria appears to be a meaningful diagnostic term that describes a set of symptoms – namely intense discomfort with one’s sexed body – it does not follow from this that one is “trapped in the wrong body,” has a “female” or “male” brain, or even a “gender identity” that doesn’t match one’s body. Though the concept of gender identity is currently being enshrined into law, the truth is that we have no meaningful definition of the term. (For an excellent analysis of the incoherence of the term, take a look at Rebecca Reilly Cooper’s work.) When a trans-identified person is asked how they know they are transgender, they are usually unable to answer the questions without reference to sex role stereotypes. For example, a physician who prescribed cross sex hormones to a 12-year-old natal female stated that the child had “never worn a dress.” This was offered as evidence of the child’s being “truly trans,” and therefore needing these hormones. I would strenuously argue that one’s clothing preferences should not be a reason to permanently sterilize a child.

It doesn’t make sense to say that one’s sex organs don’t matter, but then assert a primary, essential difference based on a sexed brain. Sexed brains do not exist. It is absurd to posit that one’s chromosomal sex, genitals, and entire reproductive system are meaningless and irrelevant or a social construct, and then assert that a subjective feeling of being the opposite gender is determinative. There is no robust science behind the notion of gender identity. Journalists have been quick to report on studies that seem to prove brain differences among those who are transgender. However, as the sexology researcher James Cantor has pointed out, these studies actually seem to be documenting brain differences among those who are homosexual.

If you want to see a review of some of the literature out there in support of a biological basis for gender dysphoria, this blog post does a good job. There are some solid studies that seem to indicate that genetics or pre-natal hormone exposure may play some role in the development of gender dysphoria. That isn’t really surprising. Pretty much every diagnosis in the DSM – from depression, to anorexia, to borderline personality disorder – has some genetic component. Gender dysphoria is real. As with other mental health diagnoses, its causes are likely complex and involve genetic, biological, environmental, and psychological factors. But it doesn’t follow from any of this that the sufferer has an inborn “gender identity” that ought to supersede any consideration of one’s objective biological sex. Body dysmorphic disorder is associated with brain differences and appears to have a genetic component, and yet the biological component of the condition does not dictate that we understand the patient’s suffering to reflect objective reality.

Transgender activists assert that “gender is between the ears, not between the legs.” However, this is an ideological, faith-based statement that cannot be scientifically validated. What is “between our ears” — meaning our inner experience of ourselves as a gendered person — is purely subjective. Within this context, asserting that one is transgender is an unfalsifiable statement of belief. In reality, feeling like the other sex does not in any way mean that you are the other sex. Identity is an important aspect of one’s experience. We get to define ourselves subjectively, and I would argue that full-fledged adults ought to be able to modify their bodies in accordance with their sense of themselves. However, subjective identity should not dictate a necessity for medical treatment of any kind, especially body-altering treatments with highly significant side effect profiles for minors or young people

An identity model does not allow us to consider treatment outcomes critically. The research on outcomes post transition is mixed at best. It is well-known that one study showed that 41% of transgender people had experienced suicidal ideation or self harm. It is less well-known that the study gives no indication whether the attempt was before or after receiving transition care. Several large studies show astonishingly high rates of suicide among transgender people who have medically transitioned (see here and here). It has been argued that suicide rates continue to be high after transition due to societal prejudice. While this likely is true some of the time, post-transition transsexuals are more likely to “pass” as the target gender, and therefore ought to be less subject to discrimination. Given the undeniably high rates of suicide in post-transition transsexuals, it is disingenuous to claim that transition is a panacea that will prevent suicide.

While this study showed positive outcomes for early transition, there were only 55 subjects included. Perhaps more importantly, they were last assessed at one-year post sex reassignment surgery. In the survey of detransitioned women, the average length of transition was four years. It seems possible that some of the 55 individuals followed in the first study might go on to have regrets if they were followed for longer. Worryingly, one of the 70 individuals invited to participate in the study was unable to do so because the person died as a result of postsurgical necrotizing fasciitis after undergoing vaginoplasty.

While the media is full of stories of young people becoming happier and more confident after being allowed to transition, there is some evidence that this is not always the case. In addition to the research that documents high suicide rates post transition, I am aware of anecdotal evidence of continued or even increased anxiety and depression, social isolation, psychiatric hospitalization, and poor academic outcomes for those who have transitioned.

An identity model does not allow us to explore other options for dealing with dysphoria. Transition – social and medical — is currently the only treatment commonly prescribed for gender dysphoria. If what we are treating is an acute discomfort with one’s body, it would seem reasonable to offer a range of different treatments before prescribing transition, including anti-depressants, talk therapy, and emotion-regulation skills to help patients manage their distress. However, none of these treatments is routinely prescribed for gender dysphoria. In the survey of 200 detransitioned women, some significant percentage of them stated that they found alternative ways of dealing with dysphoria other than transition. Detransitioner and therapist in training Carey Callahan offers several specific techniques that she has found helpful on her blog. Clinicians and researchers ought to be mining these experiences to find other effective treatments for dysphoria in addition to transition.

whitman-quote-2

An identity model makes some questionable assumptions about the nature of identity and our ability to know ourselves. An identity model is predicated on the notion that identity is immutable, essential, and knowable. This is not my experience of human nature. Identities are useful for approximating something about ourselves. They are constructs that allow us to talk about our experience. But they are not absolute truths, and they rarely say something about our most essential, mysterious, and ultimately unknowable essence. To quote Whitman, “do I contradict myself? Very well, then, I contradict myself. I am large. I contain multitudes.” I have had the good fortune to contradict myself many times in my life – contradict myself on things that at one time felt utterly essential and absolutely true. I believe this is a universal human experience, and yet another reason why making permanent changes to one’s body at a young age ought to be approached with extreme caution.

An identity model makes it impossible for us to acknowledge or discuss the varied reasons why a person might want to transition. The desire to transition likely has many varied causes. Seeing all transitions as an expression of innate gender identity obscures the very real differences between one person’s situation and another, making it impossible to assess and treat people in an individualized way. A late transitioning MtT autogynephile has an experience of gender dysphoria that is vastly different than that of a fifteen-year old lesbian, and the former’s experience ought not in any way to dictate how we understand or treat the latter.

An identity model creates a false dichotomy between affirmation and bigotry. According to the current narrative, the only supportive response to a teen who has self-identified as transgender is to affirm this identity and begin transition immediately. Any other response is quickly labeled transphobic. In reality, there is a huge range between assisting a child in transitioning immediately and affirming that they are and in fact always have been the opposite sex, and denigrating or shaming them for their desire to transition or coercively trying to get them to conform to rigid gender expectations. Parents can communicate their unconditional love and support. Parents can offer solace and warmth as the child struggles with distressing feelings. Parents can seek legitimate psychotherapeutic help to offer space for the young person to explore and understand the desire to transition. Teenagers often develop strong beliefs about what they must do or have, and it is well known that these beliefs and demands are not always sound or rational. Never before have parents of teens been told that they have to accede to the demands of their teenager or risk doing irreparable harm. Parents of teens have always had to step in and set loving limits on behavior that may not be in the young person’s long-term best interest. When dealing with a child who has diagnosed themselves as transgender, parents can do what parents of teenagers always do – set sensible limits and help a child to reflect on the potential consequences of his or her actions. Parents can assure the child of their ongoing love and acceptance if he or she does eventually decide, as a full-fledged adult, to transition.

An identity model offers an inferior kind of therapy to those who identify as transgender. As the blogger Third Way Trans has pointed out, “if someone is a member of a dominant class they receive regular psychotherapy but if they aren’t they receive a special kind of social justice therapy.” Those who come into treatment with gender dysphoria are not given the opportunity to explore deeply their experience, but instead have their self-diagnoses affirmed. There are people who will need to live as the opposite sex in order to have the happiest, fullest life possible. These individuals may need to consider taking hormones or having surgery. Surely these people deserve to have a place to explore these consequential decisions without prejudice in favor of a specific outcome so that a process of careful discernment can take place. If therapists are only cheerleaders for transition, how can someone in this situation get help to make the best decision?

I believe we should offer clients with gender dysphoria high quality mental health therapy. In a guest post on this blog, a woman who considered transitioning several times during her life shared a moment from her own therapy that proved important to her.

“When I started therapy in my early twenties, I revealed to my therapist that I had been raped at 18. It had been four years and I had never told anyone. In the process of uncovering that rape and telling her about it, I stated, during a session, that I wanted to become a man. She nodded, she said she understood, and that it was something we could explore, but in the meantime, we really needed to talk about the rape. I appreciated her approach. She wasn’t directive, judgmental, or reactive, she simply stated it was something to keep talking about, but encouraged me to focus on my experience of being raped and other traumas.”

In providing high quality mental health therapy to all patients, we would communicate unconditional positive regard to our gender dysphoric patients, just as we would with anyone else, and as the therapist in this blog post did. We would greet their announcement that they feel as though they may need to transition with acceptance and curiosity, communicating that we are willing to go there with them, to explore this desire in all of its intricacy, without prematurely coming to a fixed notion of what is right for our patient. We would see the person in front of us in all of their miraculous complexity, and not just as a “gender identity.”

As therapists, we have been trained in assessment. We have been trained to wonder about layers of meaning that may not be visible at first glance. We have been trained in how to recognize and work with trauma. We have been trained to help out clients explore their labyrinthine inner lives. When clients come to me wondering whether to end a relationship with a boyfriend or change careers, we typically spend months considering all of the different facets of such a decision. Don’t we owe at least as considered a process to someone contemplating making permanent changes to his or her body, especially when that person is a teen or young adult?

Announcing a new online survey for detransitioned women

Cari is a 22-year-old detransitioned woman who was interviewed recently on 4thWaveNow about her experiences as a former teen client of Transactive Gender Center in Portland, OR.  Cari wrote to us today to announce an online survey she has created for women who are reclaiming themselves as female.  I’ll let her introduce her work in her own words shortly. But first, if you have not had a chance to watch Cari’s very powerful YouTube video,  please do so. In it, she deftly takes apart a post on trans youth, desistance, and detransition by trans activist MtoF Julia Serano.

Cari is not the only detransitioner talking back to Serano. Several other women have come forward in recent days to eloquently and incisively describe the many facets of the female detransitioned experience, including Maria Catt and crashchaoscats. Transgender Trend also posted an excellent response to Serano.

Now I’ll let Cari introduce her Survey of female detransition and reidentification. Please share widely!


This survey is for anyone female/AFAB who formerly self-described as transgender. This includes women who transitioned, whether socially and/or medically, and have subsequently detransitioned, as well as individuals who still identify as nonbinary or genderfluid, but have desisted from medical or social transition. The purpose of this survey is to provide information about the demographics of those who detransition and reidentification, motivations of individuals to detransition, and survey general attitudes of female detransitioners towards transition.

I’m posting this as a way of getting some data about detransitioned women where none seems to exist, particularly regarding motivation to detransition and the efficacy of managing dysphoria without transition. This survey is short due to surveymonkey’s question limit, and not very scientific, however I may create a longer and more controlled one in the future, should there be interest in that.

The adolescent trans trend: 10 influences

The below post is written by Overwhelmed,  4thWaveNow contributor and the mother of a teen daughter who insisted she was transgender, but who subsequently changed her mind. Other parents in the same situation have shared their experiences on 4thWaveNow, and a new research study (currently recruiting) is the first to systematically examine the phenomenon of “trans trending” amongst tweens and teens.

Trans activists and gender specialists constantly assure us that puberty blockers are harmless and “fully reversible.” They claim these drugs “buy time” for a young person to decide if they really are trans. But given that social transition + puberty blockers are followed in 100% of reported cases by cross-sex hormones (see here and here),  the “buying time” assertion deserves a lot more scrutiny. If there weren’t other forces at work (like social contagion and the conditioning effect of being validated in the idea that you are “really” the opposite sex if you prefer the appearance and lifestyle of that sex), a 100% persistence rate in trans-identification simply wouldn’t be happening.

And when it comes to teens who experience onset of gender dysphoria in adolescence, parents like Overwhelmed, Penny White, and the founder of this website–who have personally observed their teens voluntarily desisting from a trans identity–are the ones who have actually bought time for their kids: precious time to realize that becoming a lifelong patient haunting the offices of endocrinologists and plastic surgeons is not the only way to live a gender-defiant life.


by Overwhelmed

Earlier this year, a Nature article reported on the May 2016 launch of a study aimed at documenting the psychological and medical impacts of delaying the puberty of trans youth:

 Funded by the US National Institutes of Health (NIH), the US $5.7-million project will be not only the largest-ever study of transgender youth, but also only the second to track the psychological effects of delaying puberty — and the first to track its medical impacts. It comes as the NIH and others have begun to spend heavily on research related to the health of transgender people, says Robert Garofalo, a paediatrician at Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois, and a leader of the study. “We seem to really be at a tipping point,” he adds.

Garofalo and his colleagues aim to recruit 280 adolescents who identify as transgender, and to follow them for at least five years. One group will receive puberty blockers at the beginning of adolescence, and another, older group will receive cross-sex hormones. Their findings could help clinicians to judge how best to help adolescents who are seeking a transition.

Despite the fact that puberty blockers–followed in nearly every case by cross-sex hormones–have been prescribed for many years for “trans kids,” this study will be the FIRST in the United States to track the impacts of medical transition on this population. It has become increasingly popular for gender doctors to start trans-identified children on puberty blockers. The rationale is to avoid the potential psychological distress and the physical development of secondary sex characteristics associated with the “wrong puberty.” Based on the constant onslaught of celebratory articles about “trans kids” in the media, the public is likely unaware that puberty blockers and cross-sex hormones are not approved by the FDA for this purpose. These drugs are being used off-label and the science isn’t settled by any means. Even the gender doctors confess there is no medical consensus.

I appreciate that the Nature piece is not just another one-sided article touting pro-transition dogma. Although the journalist failed to mention that children who pause their natal puberty, and then directly proceed to cross-sex hormones, have the not-so-insignificant consequence of permanent sterility, she did include viewpoints not often seen in the mainstream media:

 “But some scientists worry that putting off puberty in older children may disrupt bone and brain development, reducing bone density and leading to cognitive problems.”


 “Because most children who question their gender do not do so past adolescence, many psychologists discourage “socially transitioning” until the teenage years.”


The debate is so heated — and evidence so sparse — that the authors of the American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were unable to reach a consensus. “People are making declarations of knowledge that are their belief systems, that aren’t also backed up by empirical research,” says Jack Drescher, a psychiatrist at the William Alanson White Institute in New York City.”

 But there is one assertion in the article–touted as settled science—that raises a huge red flag:

 “But those who identify as transgender in adolescence almost always do so permanently.”

Many parents who read 4thWaveNow are VERY familiar with this assumption. When their child, out of the blue, with no prior history of gender dysphoria, claims to be transgender, most parents resort to internet searches to become more knowledgeable. They read articles like this one by Irwin Krieger, LCSW, which tells parents it’s pretty much inevitable their teen or young adult child will remain transgender:

 …I do acknowledge that most teens who have come out to parents and others as transsexual are truly transsexual so as not to give them any false sense of the likelihood of their child having a change of heart.

Parents are encouraged to just start “supporting” their child by using the correct pronouns, buying new clothes and aiding their child with social (and possibly medical) transition.

Historically (prior to the year 2000), the research data did show that many kids who consistently believed they were the opposite sex during and after puberty held onto this belief into adulthood. But in the last few years, something new has emerged: a wave of post-pubertal, self-diagnosed trans teens.  These youth may not fit the historical profile due to relatively recent influences like:

  1. The social contagion phenomenon. Many confused teens and young adults (and increasingly, tweens) seek out answers from strangers online. They say they don’t “fit in,” that they prefer clothing and activities usually associated with the opposite sex. They ask, “Does this mean I’m transgender?” The answers they receive frequently affirm they are and urge them to “Transition NOW!” Places like Tumblr, Reddit, and YouTube (MTF and FTM transition videos) are full of this “wisdom.” The blog Transgender Reality documents some of these conversations.

Sometimes it isn’t an online influence that sparks a newly realized transgender status. There are more students socially and medically transitioning in high schools and universities. On some campuses there are entire friend groups claiming to be transgender, and an impressionable child who is befriended by this group may suddenly decide he/she is trans as well.

  1. The ability to achieve an instant “special” status. There is an appeal for some to identify as transgender in order to receive extra attention or boost their social standing.

If a student announces to school administration that they’re transgender, it’s becoming taboo to question them. More schools are enacting guidelines (like this one co-authored by the National Education Association) that enable children to be treated as the opposite sex, regardless of maturity level or mental health status. And parents don’t need to be in agreement, or even informed, about these accommodations.

Additionally, some children and/or their parents may be enticed by the potential to become celebrities. After all, Jazz Jennings and Caitlyn Jenner have their own TV shows strictly based on their transgender identities.

  1. The reduction in gatekeeping. The current train of thought among gender doctors and therapists is that gender identity is innate, unchangeable, and is often realized at a very young age. If you follow this line of thinking (and assume that no one could possibly be confused or misled into believing they are transgender), then you likely feel it is unjust, and even harmful, to make a child jump through gatekeeping hoops before medical treatment.

As an example of this logic, Dr. Johanna Olson-Kennedy, the medical director of the Center for Transyouth Health and Development at Children’s Hospital in Los Angeles, was recently quoted in this article about Sam who was given puberty blockers, then began testosterone injections and had a double mastectomy all by the age of 14:

 “It is pretty well proven that people know their gender by the age of 5,” said the Center for Transyouth Health and Development’s Olson. “If we accept and believe that people know their gender by the age of 5, why not accept that trans kids know their authentic gender?”

Treating young people with gender dysphoria is critical, Olson said, as puberty increases the chances they will harm themselves.

“One of the things that puts trans kids at higher risk is this period of time when they are going through puberty,” she said. “Their body is becoming the adult or permanent version of this body they are not comfortable with.”

  1. The push for transgender identities to be seen as a normal variation of human existence (like homosexuality). It has become more common for doctors and therapists to avoid labeling people who think they are the opposite sex as having a mental disorder. An example from Jack Drescher is in this article about the World Health Organization classification system:

When ICD-11 is published, being transgender will be listed in a different part of the document, potentially under conditions related to sexual health, said Drescher, who is a New York psychiatrist and a professor of psychiatry at New York Medical College. “So they’ll be diagnoses, but they won’t be mental disorder diagnoses.”

The medical community’s process of de-stigmatizing being transgender was also reflected in the last round of updates to the Diagnostic and Statistical Manual of Mental Disorders in 2013.  The DSM, which is used by clinicians, replaced the diagnosis of “gender identity disorder” with “gender dysphoria.” The diagnostic class was also separated from sexual dysfunctions.

Identifying as transgender shares some similarities with anorexia nervosa  and body dysmorphic disorder for which treatment consists primarily of therapy and possibly medication. But the regimen for gender dysphoric patients often includes medical interventions to physically alter their bodies to better align with their feelings, making this condition treated like no other mind/body disconnect.

  1. The popularity of early social transition. It’s becoming increasingly common to socially transition prepubescent children, to encourage them to live as the gender with which they identify. In the Nature article cited above, psychologist Diane Ehrensaft (a proponent of the gender affirmative model) and transgender rights attorney Asaf Orr comment on this approach:

But encouraging children to live as the gender they identify with is an increasingly popular choice. “There’s been a real sea change,” says Diane Ehrensaft, a psychologist at UCSF. She reports seeing more prepubescent patients recently who have already transitioned socially.

Many transgender-rights activists support this model, and liken any other approach to gay-conversion therapy. “You’re telling a kid, ‘I don’t believe you’,” says Asaf Orr, staff attorney at the National Center for Lesbian Rights in San Francisco. The best strategy, he says, is “to affirm a child’s gender exploration, regardless of what the end result is going to be”.

The gender affirmative model encourages children to “explore” their gender identity through social transition. It is often stated that it’s harmless to do so since no hormones or surgeries are involved. But this doesn’t take into account that children who are treated as the opposite sex are being conditioned to continue in their belief, potentially leading to future medical interventions. Even the Dutch researchers who pioneered the use of puberty blockers to treat transgender youth, do not recommend social transitioning in prepubescent children due to the “high rate of remission.”

dutch anti social transition

6. Transactivism. There is a burgeoning group of people who are out to educate the world about the importance of accepting transgenderism. Their pleas are often presented as anti-bullying or anti-discrimination campaigns. They tend to cite high suicide rates and imply that misgendering someone or questioning their gender identity may contribute to these statistics. Many of these activists are transgender themselves and feel they are the most knowledgeable about their condition. They pass themselves off as experts. Many conduct training sessions in schools, police departments, hospitals, etc. They write books, media articles, blog posts. Host conferences. Just one activist can have considerable influence. And there are so many voices shouting this philosophy that it drowns out opposing viewpoints.

7. Framing transgender acceptance as the new civil rights movement. Personally, I was elated when the US Supreme Court declared same-sex marriage legal. But, after that triumph, organizations like the Human Rights Campaign (HRC), the American Civil Liberties Union (ACLU) and the National Center for Lesbian Rights (NCLR) seem to be focusing more intensely on the transgender rights movement.

It is admirable to oppose discrimination against transgender people in employment, housing and appropriate health care. And I very much condemn violence against them. But there needs to be a balance. It should be acknowledged that some impressionable children, teens and young adults are confused and erroneously self-diagnose as transgender. This vulnerable population needs protection from unnecessary medical interventions. But since these organizations promote the “born this way” dogma, anyone who doesn’t blindly accept and support them as the opposite sex, is called misinformed or even abusive and bigoted.

In a short period of time, the transgender rights movement has made substantial gains. There have been laws passed in the United States and Canada that could be interpreted to mean any therapy that doesn’t affirm a youth’s gender identity is illegal. US schools are being pressured to allow transgender-identifying students into opposite sex bathrooms, locker rooms, and even bedroom assignments on overnight field trips. Overall, there has been a tendency in recent guidelines, legislation and court cases to prioritize gender identity over sex.

  1. The significant growth of the gender industry. There has been a rise in demand for gender clinics, doctors, therapists, endocrinologists, surgeons (and even “packers”—penile prostheses) due to the rapid increase in gender dysphoric children.

Back in January 2016, this pro-transition Cosmopolitan article stated that the first US transgender youth clinic opened in Boston in 2007. And since then 40 more have begun catering—exclusively to children—in the United States.

Surgeons are finding their services are increasingly sought after as well. Dr. Curtis Crane (who performs mastectomies on minors) has commented on how he cannot keep up with the demand for phalloplasties, even though he keeps training more surgeons in the technique:

 Crane says he’s one of only a few surgeons in the U.S. performing a high volume of phalloplasties — a booming surgical niche fueled by an increasing number of transgender men seeking to complete their anatomical transition. Even after hiring and training two colleagues to perform the eight-hour surgery, Crane’s patients must wait a year to have it done.

I frequently come across statements from doctors and therapists saying their transgender-based business is flourishing, often with a significant backlog. Due to their expertise, these are the professionals that I wish would speak out about potential over-diagnosis and over-treatment of trans-claiming youth. You have to wonder if they truly see the massive increase in patients as a positive (“more people are finally being treated because they are better informed and there is less stigma”). Or do they see trouble on the horizon (“I’m pretending everything is peachy, but I’m really concerned this may be a disastrous medical trend”)?

  1. Selective media coverage. Many media outlets portray positive “trans kids” stories, but choose to omit information not favorable to the transgender rights movement. Usually there is no discussion of the high desistence rates, or of the significant risks associated with medical treatments. And when facts like these are not included, the public is misinformed.

US media is chock-full of pro-pediatric-transition stories, many of which have been discussed on this site. You can also click on the Transgender Trend blog links below for examples and excellent analysis of biased programming from the UK’s BBC:

  1. The silencing of skeptics. Unfortunately, it is taboo to voice concerns that children, teens and young adults may be at risk of unnecessary medical transitions. This blog is one of the ONLY places online that parents and their allies can speak out, although most choose to do so anonymously to maintain their privacy.

Unfortunately, there are some trans activists, deeply offended by anyone contradicting the transgender narrative, who work to discredit anyone who dares to express opposing viewpoints. To these activists, it is fair game to try to get someone fired from their job or to post pictures of their children with sexually explicit captions (see the Michael Bailey link). Alice Dreger, Michael Bailey and Kenneth Zucker have been recipients of this treatment.

On a positive note, I’ve heard there are a growing number of professionals—doctors, nurses, teachers, journalists—whispering their concerns to each other. But due to the current environment, they’re afraid to speak publicly. Afraid they’ll be called bigots. Afraid they’ll lose their jobs.

We are living in a time when the number of gender dysphoric children is rising exponentially with no sign of a leveling off.

Guardian increase in peds transition graph

Kids are being medically transitioned regardless of the fact that there’s no medical consensus of what the best treatment options are. No one knows the long term consequences of puberty blockers, cross-sex hormones and surgeries in this population. This may very well be a disastrous fad similar to the false memory and ritual abuse scares of the ‘80s and ‘90s. And to top it all off, there’s significant pressure not to publicly express skepticism.

Mainstream media involvement would be welcome, along with brave professionals speaking up about their concerns. It is essential that the public be informed not only of the pros, but also the cons, of transitioning children.

Instead of focusing solely on treating the burgeoning number of gender dysphoric children, professionals ought to investigate the reasons for the radical shift in this population. Why are so many presenting to gender clinics? Why are there currently so many females vs. males seeking treatment (historically it was the opposite)? Why do so many have co-morbid mental health issues—autism spectrum disorders, OCD, ADHD/ADD, depression, etc.? These are important questions in need of answers. Especially because of the often irreversible nature of medical interventions, and that the patients are children with the rest of their lives ahead of them.

Today’s children are exposed to all kinds of influences that weren’t present until relatively recently. It would make sense to now reject the statement “those who identify as transgender in adolescence almost always do so permanently.” And to re-evaluate treatment protocols so that children, teens and young adults receive the thorough mental health care they need, and avoid any unnecessary medical interventions.

Jenn Burleton, director of youth transition org, dismisses ex-client’s complaints as “TERF infestation”

This is an update to Friday’s post. Please read it first for background.


UPDATE June 14, 2016: TransActive Gender Center and director Jenn Burleton have issued public statements on their Facebook pages. TransActive has labeled 4thWaveNow an “anti-trans hate site” because we have provided a platform for Cari to tell her story.

TA statement June 13 2016

It’s a common tactic of trans-activist organizations, which can tolerate no dissent, to dismiss critics of pediatric transition as “transphobic” or “hating trans children.” We at 4thWaveNow–the majority of us being concerned parents of gender nonconforming youth–invite all readers to investigate the posts, interviews, and research-based information on our site and decide for yourselves whether 4thWaveNow “dispenses anti-trans youth rhetoric.”


Cari, a detransitioning 22-year-old ex-client of TransActive Gender Center,  has written on her Tumblr blog about her dissatisfaction with the services provided by that organization when she was a gender-dysphoric teenager.

Jenn Burleton, director and founder of TransActive, chose to respond indirectly to Cari via a public Facebook post. When reading Burleton’s screed, bear in mind that Burleton runs an organization which has considerable influence over the lives of gender-defiant youth. In addition, Burleton is an advocate for lowering the age of medical consent nationwide, and was instrumental in changing Oregon law to allow teens as young as 15 to obtain surgeries (including mastectomy and “bottom” surgeries) without parental consent. Burleton also believes (and has stated on the WPATH public Facebook page) that TransActive’s no-questions-asked youth transition program disproves decades of peer-reviewed research demonstrating that most gender-dysphoric youth desist. In the linked post, Burleton claims a 0% desistance rate for clients seen at TransActive. Clearly, Cari’s case calls for–at the very least–some soul searching and re-evaluation of TransActive’s policies and public statements.

Burleton’s public Facebook response—aimed at a 22-year-old who was only 16 years old when she was encouraged and enabled by TransActive to medically transition–refers to Cari’s Tumblr posts as a “TERF infestation” and a “harassment campaign.” Decide for yourself, after reading Burleton’s Facebook post and Cari’s response (which Burleton has not made public), who is the injured party in this situation.

Cari told 4thWaveNow that she is grateful for any support readers can offer in publicizing her former and now current experiences with representatives of TransActive Gender Center. At her request, we are reproducing screenshots Cari posted on her Tumblr blog yesterday.

Burleton screed 1.jpg

Cari’s response, sent to Burleton via Facebook Messenger:

cari response

Cari response 2

Cari response 3

Therapist letter.png

Brain sex: The jury is still out—but does it matter?

Early this morning, Think Progress (a “progressive” news outlet) posted on Facebook what was meant to be a provocative pull-quote from its latest trans-kid piece by reliable journalist propagandist Zack Ford, “It Takes A Village To Bully A Transgender Kindergartner”:

And what exactly is the “need” of this child? A boy in kindergarten would like to be accepted as “girl”? Well, as a woman, I take offense at any boy who is pretending to share my gender when he quite clearly NEVER can nor ever will. … He is not. He never can be.”

The commenter quoted is, of course, a woman (a bigoted bully, as seen through Ford’s tunnel-vision lens) who questioned the parents’ need to socially transition their 5-year-old child. The child’s transgender status has resulted in a giant kerfuffle as result of the Minnesota school’s dilemma in deciding what to do to accommodate the kindergartner.  Zack Ford paints anyone who questions the wisdom of a 5-year-old boy being assured he is really a girl as an ignorant transphobe, a bigot supported only by right-wing conservative groups.

Zack Ford Facebook
In this post, I’m not going to be writing about the fact that it isn’t just conservatives who question the trans-kid trend (obvious to anyone who reads this blog on a regular basis, or for that matter, the increasing number of blogs by left wing parents, professionals, and feminists. Check out my blogroll). Nor will I be dissecting in detail this “news” article set out as bait on the Think Progress Facebook page to incite the reliable progressive hordes.

Instead, my interest in Ford’s latest bit of Newspeak revolves around the huge number (easily 10-1) of reader comments on that Facebook post, which can be paraphrased as follows:

You stupid bigots! Go read up on the science of gender identity. Gender identity is proven, settled brain science. Little kids KNOW from the time they’re born what sex they are. Plus intersex. No one “chooses” to be transgender, they’re born that way.

 I’ve spent thousands of hours marinating in gender dogma and research studies, both pro- and con-, re: “innate gender identity.” So while it’s no surprise to me to see some people spouting as FACT the totally unproven hypothesis that gender identity is set in stone at birth, what does surprise me is the sheer numbers who have bought what, at best, is a tenuous theory, and who have thereby completely shut down even a modicum of critical thinking.

Of course, who can blame well intentioned progressives? They’re fed bittersweet mouthfuls of Innate Gender Identity gruel every single day not only by the media, but even by the President of the United States, who via his Department of Justice, baldly asserts on line 36 of the complaint against the state of North Carolina:

36. Gender identity is innate and external efforts to change a person’s gender identity can be harmful to a person’s health and well-being.

DOJ complaint

US v. North Carolina

(And it’s not just these few lines. The entire complaint reads like boilerplate trans-activist dogma, and interested readers are urged to take a look at the rest of this document).

This increasingly unchallengeable notion that gender identity, aka “brain sex,” is innate, hard-wired at birth, and thus absolutely unchangeable (despite the efforts of us horrible bigoted parents who are rooting for our kids to commit suicide) means, to the masses who now parrot it like the top graduates of a Maoist Re-Education Camp: Every toddler who claims to be the opposite sex must be agreed with by every adult who comes in contact with the child. Innate gender identity is the ironclad reason why no one is supposed to question the sudden flood of “trans kids” we hear about on a daily basis.

Given the gravity of all this—that little kids are now being ushered aboard a train that will lead inexorably from puberty blockers to cross-sex hormones (with concomitant irreversible changes) in 100% of reported cases–these brain sex/innate gender identity claims can’t just be ignored and dismissed. Not when so many  people—more every day—have swallowed them whole.

Here’s the thing. There is some research that supports a role for biological, genetic, or physiological factors in gender dysphoria. And as much as people on “my side” of this argument (the argument being: should children be “transitioned” to the opposite sex on their own say-so?) would like to simply dismiss any and all evidence for biological aspects of things like gender dysphoria, it’s not that simple.

Shunning entire lines of research because we are made uncomfortable by the findings should not be the way of truth seekers. If opening our minds to their claims changes our position, then so be it. As medical historian and intersex-rights activist Alice Dreger says in her book Galileo’s Middle Finger which chronicles (among other things) the chilling effect of activism on scientific inquiry,

[it is] a rare trait in activists: a belief in evidence even when it challenge[s] our political goals.

Human beings, in general, do not appreciate having their cherished ideas challenged. Political viewpoints tend to be set in stone, with any wavering seen by one’s allies as a dangerous and slippery slope. Evidence contrary to the ideological convictions of either side is taken as an existential threat to the fundamental integrity of the position.

For instance, people (like me) who support a woman’s right to abortion often avoid  acknowledging the fact that a fetus is not just an amorphous mass of cells, but a proto-human being. Conversely, anti-abortion advocates give short shrift to arguments about a pregnant woman’s agency over her body, and the critical importance of a baby coming into the world to a parent who is ready–and can financially afford–to raise the child.

The battle lines dividing those who support the idea that self/parent/activist-identified “trans” kids should be transitioned as young as possible, vs. those who disagree (like me) are drawn across a long-contested and hardened piece of ground: nature vs. nurture. And the opposing combatants are highly reluctant to give even an inch on the matter.

As you’ll see, this post is going to argue not for a détente or concession of territory, but rather, for a willingness of “my side”—the gender critics–to consider the evidence marshaled by our detractors, and then ponder whether it changes your mind. I’m only going to touch on a few areas of research typically used by the trans activist side; if you’re interested, you’ll want to spend some delving time yourself.

Let me cut to the punchline right now: Speaking for myself, weighing the claims (and the research they base it on) of the activists who want to transition children as early as possible has actually strengthened my conviction that medical transition should be an adults-only decision, if made at all. The only thing I can say I might have shifted my opinion on after endless investigation is this: There may be a very small (it’s always been very small) number of people for whom medical intervention is the only way they can live a happy life. I don’t believe we should prohibit these interventions for such people as adults. I still do not believe, weighing up all the evidence, that we should be tampering with the bodies of young people who may very well grow up to be happy without the expensive, drastic, and irreversible meddling of the gender-soaked medical and psychiatric professions. Instead, as I harp on constantly, let’s celebrate and support gender defiance in young people.

So let’s start with the obvious. [Note to regular readers: The information in the next couple of paragraphs is well known to you, but please stick with me, because I’m going to cover some research I haven’t formerly written about]. If gender identity is “innate” how come so many gender dysphoric youngsters change their minds?

4thWaveNow is chock-a-block with posts and research studies—as well as personal narratives from formerly trans-identified people who changed their minds, as well as others who experienced and resolved severe gender dysphoria in childhood—supporting the fact that many children outgrow their dysphoria and grow up to be adults happy to have bodies and brains that have not been tampered with by the medical and psychiatric professions. A 2008 meta-study by Korte et al sums it up:

Multiple longitudinal studies provide evidence that gender-atypical behavior in childhood often leads to a homosexual orientation in adulthood, but only in 2.5% to 20% of cases to a persistent gender identity disorder. Even among children who manifest a major degree of discomfort with their own sex, including an aversion to their own genitalia (GID in the strict sense), only a minority go on to an irreversible development of transsexualism.

Because so many trans activists claim that intensity of discomfort with one’s body parts is some irrefutable sign of “true transgender,” or that prior researchers didn’t adequately differentiate between “true trans kids” and the merely “gender nonconforming,” I’m going to emphasize this bit of the above quote:

even among children who manifest a major degree of discomfort with their own sex, including an aversion to their own genitalia.

Even WPATH—World Professional Association for Transgender Health—whose clinician-activists spend a good deal of time promoting younger and younger ages for “transition,” acknowledges on page 12 of its Standards of Care that most trans-identified kids grow out of it:

In most children, gender dysphoria will disappear before, or early in, puberty.

An earlier online version of  the WPATH SOC-7 cited specific numbers—greater than 80%–and included research citations, but this more specific information, oddly enough, has disappeared. But this 2014 study remembers:

…as the World Professional Association for Transgender Health notes in their latest Standards of Care, gender dysphoria in childhood does not inevitably continue into adulthood, and only 6 to 23 percent of boys and 12 to 27 percent of girls treated in gender clinics showed persistence of their gender dysphoria into adulthood.

Ok. So most kids grow out of gender dysphoria. But that fact doesn’t by itself dispense with biological evidence for gender dysphoria, whether or not it persists.

Traditionally, feminists have staked their claim on the “nurture” side of the “gender identity is innate” argument, with little acknowledgement of the findings in biology and neuroscience that hint at any real difference between male and female brain physiology.  And there is plenty of hard science bolstering this nurture-based stance: recent MRI studies have mostly corroborated the view that male/female brains are more alike than different, which leads to the conclusion that sex-role stereotyped behaviors are primarily the result of socialization, as Cordelia Fine laid out in her “Delusions of Gender.”

Nature_versus_Nurture

Trans activists and the clinicians who (let’s face it) follow their lead obviously point to other studies of adult transgender people which support the idea that their brains are hard-wired to be closer to the sex they “identify” with. Some of these studies do offer some evidence for sex differentiation in the brain. But imaging studies of adult brains are pretty much impossible to control, because all adults have had life experiences and social influences (not to mention possible cross-sex hormone treatments in some cases) which, owing to neuroplasticity, will of course have an impact on brain structure.

But even in the (primarily MRI) studies of adult brains that are better executed and controlled, it turns out the fundamental difference in these studied brains is not so much a matter of the subjects’ gender identity but of their sexual preference, as sexologist James Cantor draws attention to in a blog post surveying research studies frequently cited to prove a transsexual brain:

 In Scientific American Mind, journalist Francine Russo takes on a fascinating research question: “Is there something unique about the transgender brain?” she reviews some of the relevant brain research on transsexuals and concludes that transgenderism is indeed a phenomenon of the brain.  Although I agree with Russo that transgenderism is a phenomenon of the brain, I believe Russo over-focused on gender identity, which led her away from the better explanation of the data:

These brain scans don’t reflect gender identity, they reflect sexual orientation.

Cantor’s post, Russo’s Scientific American piece, and the cited research studies are all well worth reading.

There is some other research I find compelling: studies of prenatal hormone levels—specifically, testosterone—and their influence on sex-stereotyped behaviors and other characteristics in children.

A couple of years ago, Brynn Tannehill, a trans activist-journalist, posted a list of what Tannehill obviously considered to be airtight studies,  many of them revolving around prenatal hormones,  in support of innate gender identity . But are they airtight?

First, Tannehill conveniently neglects to mention that many of the cited studies (surprise, surprise) also show a link between prenatal testosterone levels and rate of homosexuality—in other words, hormone levels may have some impact on same-sex attraction.

But, more importantly, it turns out that several of the researchers linked by Tannehill have shown that the impact of hormones on both sexual identity and gender identity, while existing, is small. For example, Melissa Hines, in a 2006 paper, “Prenatal testosterone and gender-related behaviour, looked at several studies and concluded that

 Levels of prenatal testosterone predict levels of sex-typed postnatal childhood play behavior.

 Like what kinds of play behavior?

Research on girls and women with CAH has provided some support for the hypothesized influence of testosterone on human behavioural development. Girls with CAH show increased male-typical play behaviour, including increased preferences for toys that are usually chosen by boys, such as vehicles and weapons, increased preferences for boys as playmates and increased interest in rough-and-tumble play.

 Does this preference for rough-and-tumble, stereotypical “boy” play mean these kids are transgender?

Although there are fewer studies relating prenatal testosterone levels to postnatal sexual orientation and core gender identity, there is also some evidence, particularly from women with CAH or CAIS, that testosterone influences these psychosexual outcomes as well. However, these influences are substantially smaller than those on childhood play behaviour.

 

 

 

 

Prenatal testosterone levels are only a small factor in later sexual orientation and gender identity. What they are more predictive of is –wait for it—preference for non-sex-stereotyped activities! In other words: gender nonconformity (or my preferred term: gender defiance).

So some children play with stereotypically opposite-sex toys, prefer the hairstyles and activities of the opposite sex, and prefer the company of children of the opposite sex. Is it possible these preferences are at least partially “hard-wired” due to the effect of androgens on their brains? Sure. Does it follow that this means they are the opposite sex? Of course not. Nor does it necessarily mean they will grow up to be same-sex attracted, either (as I’m sure many heterosexual women who were tomboys can attest).

Let’s put a finer point on it: while some studies show that prenatal hormone levels could contribute to sex-stereotyped differences in human behaviors and, yes, sense of self, acknowledging these differences doesn’t lead to the conclusion that trans activists reach: If a child is born with a set of proclivities and tendencies more typical of the opposite sex, this means they ARE the opposite sex and medical and chemical alteration of the body is fully justified and should be pursued as soon as possible. 

What else does biological or genetic research show? In an earlier post, I argued that the only way to even begin to prove an innate male or female brain would be to scan a huge number of identical-twin newborns (before they had a chance to have any “nurture” influence—i.e., no social experiences), separate the twins at birth, then compare those brains later when the children grew up, some of whom would no doubt decide to undergo transition to the opposite sex.

For ethical reasons, this sort of research would be pretty much impossible (you can’t forcibly separate twins at birth and raise them separately, and you can’t control how kids are raised by dictating to parents how to raise them, even if you could). But an international team of researchers has looked at twins and the prevalence of gender dysphoria/transsexualism in a meta-analysis published in 2012, “Gender Identity Disorder in Twins: A Review of the Case Report Literature.”  (The full study is behind a paywall.)

Using a combination of their own clinic records and an exhaustive search of the literature, they examined a total or 44 twins of which at least one twin had gender identity disorder (GID)—the diagnostic term at the time, since replaced with “gender dysphoria” (GD). Of these, 23 were identical (monozygotic/MZ). The remainder were fraternal (dizygotic/DZ).

What were their findings?

 Nine (39.1%) of the 23 MZ [identical] female and male twins were found to be concordant for GID. In contrast, none of the 21 DZ [fraternal] twin pairs were concordant for GID.

This was a statistically significant difference, leading to the conclusion that “there is a role for genetic factors in the development of GID.” That difference in rate of gender dysphoria in identical twins matters. But let’s not lose sight of the fact that it was still a minority (39.1%) of identical twins who were both gender dysphoric.

Twin studies
In their discussion of their findings, the authors (like all truth-seeking scientists who submit their work to peer review) acknowledge that reality is nuanced:

The higher concordance for GID in MZ than in DZ twins is consistent with a genetic influence on its genesis although shared and nonshared environmental factors cannot be ruled out. Indeed, from these case reports, very little is known about the “equal environments assumption,” that is, the assumption that MZ twins are not treated more similarly than DZ twins in ways that might affect their gender identity.

In other words—“nature” appears to be a factor, but we can’t rule out nurture. ”Influence” is not causality.

And of even greater interest: In the penultimate paragraph of the discussion, we find this gem:

In the studies on genetics and sexual orientation, a higher concordance for homosexuality has been found in MZ versus vs. DZ twins. Using family methodology, there is also evidence for genetic influences [38]. In the reviewed case studies of twins with GID, from those whose sexual orientation is known, all, with the exception of Green [25], were attracted to their biological sex and nearly 50% of the non-GID twins were also homosexual, reflecting a higher percentage than found in the general population [39]. In all the cases reported to be concordant for GID, there was also concordance for sexual orientation.

Here we have it again. As Cantor noted, as I have noted, as the Dutch pioneers of pediatric transition have noted, this study finds—as nearly every study over decades has found: Whatever the precise contributions of nature v. nurture that leads to gender dysphoria or opposite-sex identification, a huge majority (if not 100%) of the studied individuals exhibit same-sex attraction by adolescence or adulthood.

I’ll hammer it home again: The constantly repeated refrain by trans activists that gender identity has “nothing to do with sexual orientation” is directly refuted in every study, as well as many of the personal accounts by trans-identified people splattered all over the media.


 So, what have we learned from looking at a few studies aiming to tease apart the nature-nurture question about gender dysphoria/opposite-sex identification?

  • there is sparse evidence of an innate male or female brain, and what differences there may be are mitigated and influenced by later life experiences. If anything, brain differences seem to indicate variations in sexual preference, not intrinsic gender identity; and
  • prenatal hormones—specifically, testosterone—have an effect, on….gender nonconforming behaviors in childhood. They have a contributing, but minor, effect on later homosexuality and gender identity; and
  • in general, there is evidence for both biological and non-biological (environmental-social) contributions to the development of gender dysphoria.

For me, it all boils down to this: Nature v. nurture is a false dichotomy. We are all the result of our genetic inheritance, hormonal influences, and how we were brought up and continue to live—which also includes both post-natal physiological influences (e.g., the various chemicals we imbibe in our hyper-industrialized world in addition to drugs and hormones we deliberately take in), as well as what we learn and experience over the course of our lifetimes.

In the end, the squabbling over nature v. nurture is a non-issue. What matters is protecting kids from the—however well intentioned—meddling of adults in children’s bodily and psychological integrity.  Whatever the relative contributions of nature and nurture to a child’s sense of self and ultimate decisions, adults should protect children from undergoing interventions that close off future possibilities.

Proponents of medical transition for children are not champions of gender nonconformity. If they were, as I’ve said many times, they would be celebrating it in children and instead of agreeing with the magical thinking of a child that this means they are “born in the wrong body,” they’d be helping these kids realize they are wonderful and unique examples of their natal sex. A healthy, fully functioning body attached to a brain is an integrated whole with that brain. It is an existential reality, no more “wrong” than the body of a person who demonstrates more sex-stereotyped typicality. By promoting the view that research evidence pointing to certain sex-stereotyped behaviors as having a biological component (however small) means kids’ bodies can be “wrong,” they are using science to limit the possibilities for children.

Puberty blockers, cross sex hormones, and surgeries for children and young people permanently limit their options. Options like: sexual experiences in an unaltered, non-surgically-tinkered-with body. Options like: Figuring out your sexual orientation, especially if you’re gay or lesbian and won’t, on average, come to terms with that fully until early adulthood. Options like: Being a role model for other kids that boys and girls can be and do or be anything, regardless of whether they fit into sex-stereotyped-typical behaviors and appearances.

Yes, a person who later decides to “transition,” who undergoes hormone treatments or surgeries after puberty may not “pass” as well as a someone who had natural puberty curtailed (and was incidentally permanently sterilized in the process). But the Cult of Passing as the opposite sex should be challenged—especially since those same trans activists who worry so much about “passing” (in perhaps their most obvious self-undermining argument) want us to also believe (for instance) that a “penis can be female.” To play Devil’s Advocate with the trans activists, if a boy’s penis can be female, you have no business promoting medical transition for anyone’s child.

Puberty blocking is not a benign intervention. While I’ll grant that, if stopped in time, GnRh agonists are “reversible” (as in, they will not prevent natural puberty), the psychological and neurological effects of delaying natural puberty cannot be seen by any thinking person as “fully reversible.” Neither is social transition “fully reversible,” for that matter. You can’t “reverse” a childhood spent cementing the idea that biological sex can be changed by a society bent on denying the existential reality of sexual dimorphism. You can’t “reverse” a message, repeated over and over to a child by trusted adults that there is something fundamentally wrong with his or her body that must be corrected.

Regarding nature-v-nurture?  Here’s what I’d say to my fellow kid transition critics:  Don’t dismiss the stuff from the “nature” side because you’ve pre-decided that any science supporting an innate contribution to gender dysphoria is a priori bunk and it’s all nurture/socialization.

In my opinion, taking seriously the dogma of the other side, examining it closely, and then coming to well-thought-out, nuanced conclusions is a much stronger place to operate from than dismissing out of hand any kernel of truth “they” might be obsessing over. That’s not truth seeking; that’s just being close-minded in service of an impenetrable ideology.

Nature-nurture—it’s both. Just like our thought-generating brains are indivisible from the bodies they’re a part of.

Your thoughts?

Shrinking to survive: A former trans man reports on life inside queer youth culture

Max Robinson is a 20-year-old lesbian who recently detransitioned after 4 years of hormone replacement therapy. She underwent a double mastectomy at age 17, performed by plastic surgeon Curtis Crane in San Francisco. Max reports that her gender therapist wrote letters verifying the immediate medical necessity of these treatments.

Max currently works to provide direct support to developmentally disabled adults living in group homes; she detransitioned on the job in December 2015. Her novel Laika, which tells the story of the little stray dog who was sent outside Earth’s atmosphere in a Soviet satellite, is available digitally or in print here. In addition, Max and her partner collaborate on many graphic art and creative writing projects.

 Max, like many young lesbians of her generation, was led down the path to FTM “transition” as a teen, effectively short circuiting her chance to fully integrate her orientation as a same-sex attracted female.  As detailed in her account, the difficulties many young trans men face in queer communities are not widely known; and the less-than- rosy experiences of FTM teens are certainly not discussed in the many mainstream media stories which unquestioningly celebrate testosterone and surgery as welcome treatments for dysphoric girls—many of whom are same-sex attracted.

Max’s story will also appear in an upcoming anthology to be published within the year.

In the meantime, Max is available to respond to your questions and discussion in the comments section below this post.

All of us at 4thWaveNow are very grateful to Max for her courage in writing this post.


by Max Robinson

When I was 5, I led a girl rebellion. We put on capes and chased some boys in capes around. Whatever they said we couldn’t do, we did. It was mostly push-ups or holding bugs. I could hold any bug. My dad still has a picture in his office of me at a science fair, hands full of hissing cockroaches.

I hated to be told there was something I couldn’t do. In first grade, I’d go home from school all in a huff because the girls’ bathroom pass had pictures of bows on it, while the boys’ had soccer balls. My teacher wouldn’t let me choose which pass I wanted. I played soccer!

When I was in third grade, I drafted letters to the author of a children’s book series. I was bothered by the constant underlying sexism in her books about a family rescuing animals. The mom and the daughter were always secondary, sweeping or cooking in the background, while the father and son saw all the action. What troubled me most of all was that these books were written by a woman. I didn’t understand why she couldn’t create a single interesting female character.

Around the same time, my mom finally let me buy a pair of boys’ shoes. They were red and black, and I didn’t have to tie them. I wore them all the time, so often that the plastic frame of them tore through the fabric. It cut into my feet, but I didn’t tell my parents. I thought I wouldn’t get another pair. They didn’t find out until they saw the back of my ankles, torn and bleeding. When I told them why I hadn’t said anything, they got me another pair. This is my first memory of hurting myself on purpose so that I would feel better about my appearance. Later, there was tweezing, high heels, waxing, shaving, running, and trying to starve myself. In all of those, at one time or another, I was encouraged, but they really weren’t for me. I wanted to choose to hurt myself in my own way.

When I was 16, I talked my older sister into ordering me a binder, and I wore it as often I could. It hurt like hell. I insisted it didn’t. The pain made it easier to think less, which was nice, especially at school. Class was boring and I couldn’t focus, so I would always spend the whole day winding myself up with some thought obsession or another to keep busy. I would ask the teacher for bathroom breaks, and then used them to cut myself, just because I was under-stimulated and unhappy.

After school, I read Autostraddle articles and dozens of pages into the archive of FTM blogs. I was glad to see some women who looked kind of like me, saying that they had futures now. I wanted what they had, and I hated what I had. I think I was 15 or just barely 16 when I started checking this stuff out.

The longer I thought about it, the more sure I was that it was true. At first, I thought I might be genderqueer. Then, I wanted to go on testosterone for a while, but keep my breasts. Next I was sure that I wanted them gone. I would confess these changing thoughts anxiously to other trans-identifying friends online. They would reassure me that this happened to a lot of people, and that the dominant transgender narrative was oppressive.  Then I began reassuring others of this, too. We all agreed that being trans was very special and difficult.  Before, I had never felt special or that my pain mattered.

Some part of me knew I was talking myself into it. I ignored that part.

For the first time, I had a community that paid attention to me, at least online. We talked about our feelings and we listened to each other. This was my first real experience with Internet culture. I loved having friends. It wasn’t like school, where I was irritable and weird, floating between tables at lunch. People actually liked me on Tumblr. Almost all my friends were female and trans-identifying.

max jpg

I didn’t know anything. It was just so comforting to think that I was born wrong. If my body was the problem, it could be solved. Transition had clearly defined steps. Everybody chose from a set list, and when it was over, they were properly assembled.

When I renounced my connection to womanhood and what I shared with my sisters, I sealed away important parts of myself. I thought I was turning away from the hurt that came from being seen as a woman by men, but it was too late for that. That hurt has been inside my bones for years. After transition, I kept quieter than ever before. Always afraid, always afraid. Brought back into line.

Transition was supposed to fix things. That’s what I believed and that’s what doctors told my parents. I was 16 when I started hormone blockers, then testosterone. I was 17 when I had a double mastectomy.

If I didn’t look like a dyke and act like a crazy teenage girl, there would have been nothing to fix.

To fund my surgery, I started a blog where I posted print-to-order clothing and gifts, pandering to the interests of the people I saw on there. It worked pretty well. I got a bunch of money, but not quite enough. My parents used some of theirs, and my grandma helped, too. After all, this was a medically validated condition. I had been to appointments with professional after professional, all of whom agreed this was the way to go.

But it turned out to be cold comfort, removing hated body parts. Breasts marked me as a woman dressed funny. I wasn’t afraid to be anesthetized or cut open. The day of my surgery, after the doctor drew the lines of the incisions on my skin in Sharpie, I asked him where the tissue would go. He told me it would be incinerated as medical waste. I cackled. When they led me back to the operating room, I was confused. I thought there would be a silver table that I had to lie down on. I told my doctor this. He told me it wasn’t an autopsy, and laughed.

My first post-op memories don’t start until a day or two later. The pain wasn’t bad, and emptying my drains reminded me of using a menstrual cup, just with a lot more yellow stuff. It felt better than trying to live as a man with breasts. I couldn’t lift my arms to wash my own hair for a couple weeks, but seeing a flat chest was a breath of fresh air. It felt like it made sense after I had been watching my old face disappear, cheeks narrowing, beard coming in, because of testosterone. I didn’t want to be seen as a woman–as a lesbian–and I didn’t want to ask why.

Or maybe I just didn’t know who to ask. I did try. Before I started medical transition, I asked my gender therapist, a trans man, about internalized misogyny. The question was dismissed. I didn’t even really know what internalized misogyny was, but  I wanted to understand. Instead, I was assured that it probably wasn’t that. I got a letter for hormone replacement therapy, and later, for the top surgery. I was grateful.

It took years of testosterone for me to finally realize it was okay to live in my own body without it, that making this peace with myself was possible, and that I deserved that chance. I didn’t know it was okay to be a dysphoric lesbian, that I could survive this way. I was almost 20 when I stopped hormones. I had been 20 for a little while when I stopped understanding myself as a trans man.

Things changed. My mind changed.

There’s a species of rotifer (microscopic zooplankton) called Bdelloidea. A male bdelloid has never been observed. They’re all female, reproducing exclusively through parthenogenesis for millions of years. How did they survive quickly evolving parasites and rapidly changing environments without the adaptability afforded by sexual reproduction? Bdelloids shrivel up under stress. In anhydrobiosis, they’re easily carried away by the wind. For up to nine years, they’ll stay alive like this–barely living, but alive. Shrinking yourself to survive is a legitimate strategy, and sometimes it works.

After I detransitioned, I started a new job where I was known as a butch lesbian. At first, people treated me worse than when I was “passing” as male. Nobody trained me. They tried not to look at me at all. They didn’t relax until I started talking, talking like I had in high school. I made jokes and people laughed. I told them about my childhood when they told me about theirs. I did more than listen, finally. People actually liked me here, the same people who looked at me funny when I first started the job.

It had been so long since I had said anything outside my home without worrying about whether I “sounded male.” I hadn’t realized how much I had been holding back since I decided to transition. I hadn’t made new friends, except online, in years. In a couple weeks at this job, I got rides home and wedding invitations. I thought I was incapable of connecting to anyone in person, but I was just incapable of connecting to anyone as a man — because I’m not a man. I can’t pretend to be one without hiding an essential part of my nature.

I thought “woman” was wrong for me, because of how I dressed, how I related to my body, how I resented the expectations society had for me as a woman. I didn’t realize that my horror at my body could be caused by the horror of living in a world that wants to control all women.

If “being a woman” really was nothing but an identity, if I had been raised in a world where it really did just mean calling myself a woman, I never would have transitioned.  I would never have attempted to surgically and hormonally erase my femaleness. My drive to be anything but a woman was rooted in the material reality of being a woman, a material reality that cannot be identified out of. Trying to live in a fantasy where everything women have suffered for being female is null and void, even as misogyny continues to shape our lives, was valuable only in that I finally learned how incredibly valuable it was to name myself as a woman.

There is power in naming. It’s how we find each other, how we connect to our histories, how we connect to our futures. Driving us apart from each other is the easiest way to keep us from learning to recognize attempts to redefine our realities.

I didn’t know this then. I subscribed to an incredibly misogynistic set of beliefs for years. “DFAB privilege” was a common phrase in our community – “designated female at birth privilege.” It was accepted fact that being born female gave you a lifelong advantage over a male who transitioned. This included men who used transition only to mean using different pronouns on Tumblr and having an anime girl as their avatar. We believed that, as “dfabs,” we needed to shut up about our petty problems. We could never have it as hard as any “dmab women or non-binary people.” Everyone in the trans community agreed that it was our responsibility to uplift “dmab voices.” None of this seemed outrageous or strange to me; it felt pretty intuitive. Growing up under male domination is a grooming process that leaves many girls and women extremely vulnerable to manipulation.

The first experience that did make me start to feel suspicious of male transition was when I was 18 and a genderqueer-identifying man who had never pursued any kind of transition raped my best friend, a woman unacquainted with insular trans community politics. I had indirectly introduced her to this guy via mutual friends. After the rape, she told me what he did; I had been in the next room the whole night, awake, talking to someone I didn’t even like. I had no idea it was happening. When she let our mutual friends know, we both assumed they would have her back; after all, they referred to their apartment as a safe space for rape survivors. But instead, her rapist changed his pronouns on Tumblr, claimed to have schizophrenia, and then said that he couldn’t possibly have raped her, because of the power dynamics between a “cis” woman and a transwoman. He moved back to LA a few months later, without ever taking any steps towards transition. When he got there, he told his old friends he wasn’t schizophrenic or trans anymore.

Years before that, two different transwomen I knew had pressured me into sending nude photos of my breasts to them. I messaged them first, as a 16 year old, after seeing them repeatedly posting about being horny and suicidal, and how only nudes would make them feel any better. They didn’t even know who I was. To one of them, I submitted the nudes anonymously. I didn’t want to talk, I just wanted him to feel better. I thought it was my responsibility. It might still be posted somewhere, I have no idea.  Both of the transwomen who sexted with me identified as lesbians at the time and knew I was a transman. They didn’t care, as long as we were talking one-on-one.

I didn’t fully see the value in differentiating male from female until a traumatized and disabled lesbian I knew well, K, finally admitted to me that her transwoman partner M was beating her regularly.

For three years, she lived with steadily escalating physical & sexual violence, the details of which were originally included in this article but have now been removed for privacy reasons. Suffice it to say – it was an intimate portrait of what radical feminists understand as male violence.

It’s been two years since she moved in with me, away from him, and she’s still recovering from what he did to her. She had two decades of trauma before that, but nothing ever broke her like this did. Calling that relationship “lesbianism” left her stranded from the framework she desperately needed in order to contextualize her experiences as a survivor of captivity. It destroyed her ability to call herself a lesbian or a woman for a long time: if lesbians like to sleep with transwomen and were repulsed by the supposed maleness of transmen, how could she be a lesbian herself? If women are what her ex-partner M was, then she, K, must be something else entirely. The language of transition lends itself readily to abusive gaslighting that disguises and distorts women’s ability to name what is happening. What was done to her was extreme cruelty of a distinctly male variety, cruelty she was especially vulnerable to because of her lifelong history of trauma at men’s hands.

The more I started to understand that M could not have been female, the more I understood why I was. One’s actual sex matters. Running from its significance prevents you from doing anything but continuing its cycles of destruction. As soon as a transwoman said, “No, I’M not a man,” we instantly lost our ability to protect ourselves from him. Women who never transitioned in these trans circles believed their “cis privilege” rendered them man-like in their power. For those of us females (mainly lesbians) who did seek transition, we were often told that, as transmen, we were exactly as bad as any other men.

Loading the language was an incredibly powerful tool. I was a lesbian trying to save my friend from domestic violence at the hands of a man she had partnered with out of intense desperation, facing immediate homelessness as a severely mentally ill woman with limited mobility. Understanding this could have connected us to our foremothers who struggled through similar battles to protect each other from abusive men. Instead, we felt completely adrift. Other women dealing with abuse perpetrated by transwomen have described a similar sense of being in entirely uncharted territory, terrified to speak first, unable to find anyone else sharing experiences; they’re all too scared of being labeled an untouchable “trans-misogynist.”

In the 21st century, intelligent and capable adult women are having to relearn what “man” means, with fear at their backs every step of the way. We were among them, exploring radical and lesbian feminist ideology online and marveling at how decades-old works precisely described circumstances we had thought of as occurring only recently. Janice Raymond’s discussion of transexually-constructed lesbian feminists in The Transsexual Empire was startlingly relevant. She saw this coming. As lesbians, we have a rich history of theory that had been completely denied to women who came of age when K and I did. All either of us knew about Janice Raymond, until last year, was that she was evil to the core; a horrible transphobe. We believed this because we didn’t know any better.

Deprogramming took almost a year. Both of us were terrified just to read dissenting opinions. K, me, and another lesbian exited from the radical queer scene began moderating an online support group for anyone dysphoric and born female, including many who still identified as trans. When that group started, I was still one of the transmen. All of us were so incredibly relieved not to be alone. We disagreed on a lot of stuff, but we were all tired of what we saw happening to females.

When our remaining friends from the transgender community found out that we considered transwomen capable of male violence, and that we were concerned about transition’s effect on young adults, almost all of them deserted us immediately. Female trans-identifying friends who knew K’s history of homelessness and our currently rocky financial situation started talking publicly to each other about how we literally deserved to starve to death.

Losing these friends hurt enough on its own. Being cut off from them just when we had begun to see the severity of the situation within these groups was so much worse. I have a list of 20 intercommunity predators, mainly transwomen who prey on females — women or transmen. Eleven of them are one or two degrees of separation from us. So many women in our community had themselves been pressured to share nude photos, coerced into unwanted sex, or outright violently assaulted by males describing themselves as transwomen, but they still didn’t feel able to challenge the narrative they were being fed. These women, our friends, had been there with us. They saw transwoman predator after transwoman predator being named by their terrified female victims. The “call-outs” (a word used for anything from hurting someone’s feelings slightly to brutal rape) usually only happened once several victims of the same predator found each other and made sure they had friends on their side. When victims couldn’t be sure they would be supported, they didn’t come forward. The political climate made it doubly difficult to “call out” a transwoman. We were constantly being reminded that transwomen are harmed by the horrible stereotype that they’re all rapists or perverts, and we were taught that we needed to be constantly policing ourselves to avoid perpetuating this idea.

The silent victims of transwomen had good reason to keep quiet. We all saw transwomen using the language of “cissexism” and “transmisogyny” against anyone who named their behavior as harmful. Even transwomen dating other transwomen experienced abuse at their hands. In the resulting fallout, it was never clear who the true aggressor was; both of them would immediately begin using identity politics and “privilege dynamics” (i.e., someone poor can never hurt someone rich, under any circumstances, etc.) in a way that was very effective at obfuscating the truth. Our friends had been right beside us for all of this, and they still damned us for beginning to name what had enabled this wide-scale intercommunity violence.

Young lesbians in the “queer community” are known by many names: if you want to avoid scrutiny for not hooking up with transwomen, you’ve got to get creative. Some of us call ourselves queer, bisexual, or pansexual, because there’s no word for only being attracted to females, and you can’t be a lesbian if you date transmen or avoid dating transwomen. A lot of us, having been told that we can opt out of womanhood by choice, decided that we never want to be called “she” again. Young women who cling to the word “lesbian” find themselves increasingly pressured to sleep with transwomen, because—according to trans dogma–they are supposedly more vulnerable and oppressed than any “cis” lesbian.

Many transwomen seem to view dating a “cisbian” as a uniquely valuable source of gender validation. After all, lesbians only date women. There is no acknowledgement that, under some circumstances, some lesbians can be coerced into relationships that they are incapable of experiencing as anything except traumatic. I have never seen a transwoman from these circles ever express the possibility that this might be true. By all appearances, they have never considered it. Running from unpleasant truths is something that a lot of folks who transition (me included) tend to get very good at.

The insistence that lesbianism is not a strictly female experience runs so deep that transwomen, even those who only date other transwomen, often refer to themselves as “transdykes.” This includes those who are not transitioning–men who can literally only be differentiated from any other man when you ask his preferred pronouns. Many women believe that these “transdykes,” even those who have never been identifiable as anything but straight men to the outside world in any way, are more oppressed than any “cis” woman, specifically on the axis of gender. The level of gaslighting taking place here is difficult to overstate.

From the outside, now, I can finally see how ridiculous it is. Realizing this took months and months. It took us a year of exploring the feminist theory that had been forbidden to us before me or K could even call any transwoman a man without having a panic attack.

At first, when I started learning more about opposing viewpoints, I identified as a “gender-critical transman.” I knew that the transgender cause had been used in a lot of disgusting ways, but I still believed transition was the only way I could survive, and I was trying to reconcile seeing myself as transgender with believing that the vast majority of trans activism was harmful to women. During this time, I really looked up to gender-critical transwomen–transitioning males who were usually at least marginally more sympathetic and thoughtful than most men. I tried to reconcile our respective identities and our needs, as we understood them, with the needs of women as a class.

I failed. At the end of the day, I just don’t want anyone male in the bathroom with me. I don’t want them on a women’s volleyball team. I don’t want them at Curves. I don’t want them in a lesbian book club. The experience of being male is fundamentally different from the experience of being female — even if a man passes, even if a man has surgery to more closely resemble his idea of a woman. I don’t say this out of a hatred for transwomen. I say this out of love and respect for women. What we are cannot be conceived nor replicated in a man’s imagination, and it absolutely cannot be formed out of male tissue on an operating table.

The sympathy I feel for men harmed by gender, to the extent that it means I encourage male-to-female transsexualism, is in direct competition with the sympathy I feel for women harmed by gender. Everyone is entitled to make their own choices about their bodies. Everyone is also entitled to have opinions about the choices that others make about their bodies. I feel that transition is a treatment with far-reaching harmful side effects — not only for the individual receiving treatment, but for those around them.

Lesbians who see their sisters disappearing are more likely to try to erase themselves. Lesbians who are forced to welcome men into their spaces will never be able to see or understand the value of female-only space, having never actually experienced it. Transition does not cure the irreconcilability of our selves with our environments. Gendered identity crises are very real to the individuals experiencing them, myself included, but this energetic drive towards change is not best spent reforming ourselves into someone who can assimilate into the world men have built. We need to use this energy to work towards restoring balance to a sick world.

Many young lesbians (and some older lesbians caught up in a youth-oriented trans/queer culture) hold political views diametrically opposed to our collective interests. We genuinely believe some off-the-wall garbage, like that it’s wrong and evil not to be attracted to penises because of “internalized cissexism.” We have been successfully brainwashed to serve males at the expense of our own health and sanity.

I have so much empathy for other women who believed transition was their best choice. I lived that. The fact is, loving a woman does not automatically mean agreeing with her. I believe that all of us deserve better. We deserve to experience autonomous female space. We deserve the opportunity to experience our bodies as a part of nature worthy of celebration, not objects to be “reconstructed.” The energy we spend trying to run from our own bodies is better spent working to support each other.

Those of us who make it out of communities like the ones I was in often only manage to do so because of strong female (in my experience, lesbian) support networks that help us relearn how to think for ourselves without getting angry when we make mistakes in the process. I hear political opponents of the transgender movement calling it extremely cult-like and in the same breath damning the women, usually lesbians, who fall into the trap. This reinforces the learned hatred of anyone who disagrees without creating any opportunity for victims of this ideology to ask questions and explore viewpoints that—while the victims have not yet extricated themselves–genuinely feel like some kind of blasphemy to them. The pace of progress needs to be determined by the individual. Frustration with the behavior of young people in the transgender community is very understandable, but even the most righteous anger is unlikely to change minds when it’s directed at someone who has been manipulated into believing that dissenting women are literally equivalent to murderers.

The beliefs they have internalized are harmful to all women. No one is obligated to subject herself to being triggered or re-traumatized by the virulent misogyny that trans activists tend to espouse, even in the name of reaching out to a sister in crisis. Taking care of yourself has to come first. I try to stay available for conversations with questioning trans-identifying females, but I can’t always be there. I need rest, too.

As I move away from viewing myself and my body as an object to improve, I’m realizing more and more how much of my energy has been devoted to appeasing men in some way. By and large, that was a waste of time. I’m working on using my emotional energy for the benefit of myself first, and then for the benefit of other women.

While I was transitioning, I was terrified of eventually regretting it. I sure as hell didn’t let on much about my doubts, for fear of losing access to medical treatment, but I was consumed all the time with obsessive thoughts about it. I didn’t understand how I could go on living as a woman with no breasts. What man would want to fuck me? Never mind that I didn’t want to be fucked by any man; that didn’t feel like a good enough answer.

I am so incredibly grateful that I learned that there was more to being a woman. Transition was absolutely not the easiest way to learn this, but it was how I learned it. It was how I learned that I could survive without men viewing me as a piece of meat. I never shaved my legs or armpits again. I stopped tittering at their stupid jokes. I dress practically. I’m grateful that I learned it was okay to exist as I am.

For me, transition was a processing of distancing my true self from my body and my environment. Detransition has been the opposite: learning to participate earnestly in the world again. For me, this isn’t about undoing my transition. I’m not seeking any further changes like electrolysis or breast reconstruction. I am a woman, even if my body is recognizable as the body of a woman who once thought transition was the best choice available to me. My body has known tragedies, but my body is not a tragedy. When I catch myself slipping into deeply misogynistic internal tirades about the aspects of my appearance that changed during transition, I practice thought replacement. I am not a waste of a woman.

I’m so grateful for all of the incredible women I’ve connected with who are on the other side of transgender identities now. Some of them are women I met years ago, when both of us were still pursuing transition. Transition doesn’t have to be forever. If transition makes you sick inside, you don’t have to live and die with that sickness. There is community. There is processing. There is genuine healing. More and more of us are waking up, each with her own story. We question and disagree, with our enemies and with each other. We learn. Together, we are moving forward.